Where can I find information on Home Health Billing?

QUESTION: Where can I find information on Home Health Billing?

ANSWER: Comprehensive information on Home Health billing can be found in Chapter 10 of Medicare’s Claims Processing Manual.



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modifiers T5

QUESTION: If the same procedure was done on the great toe of the right foot and on the great toe of the left foot, how is it coded?

ANSWER: Report the procedure code once and append modifiers T5 (right foot, great toe) and TA (left foot, great toe) to the code. CMS currently accepts up to two modifiers per line.





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modifier -91 be reported under CCI

QUESTION: How should modifier -91 be reported under CCI?

ANSWER: Modifier -91 should be appended to laboratory procedure(s) or service(s) to indicate a repeat test or procedure on the same day. This modifier indicates to the carriers or fiscal intermediaries that the physician had to perform a repeat clinical diagnostic laboratory test that was distinct or separate from a lab panel or other lab services performed on the same day, and was performed to obtain medically necessary subsequent reportable test values. This modifier should not be used to report repeat laboratory testing due to laboratory errors, quality control, or confirmation of results.

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CPT code 99291

QUESTION: What services are included in CPT code 99291 (critical care, first 30-74 minutes) and should therefore not be billed separately?

ANSWER: Hospitals must follow the CPT instructions related to CPT code 99291. Any services that CPT indicates are included in the reporting of CPT code 99291 should not be billed separately by the hospital.





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Medically Unlikely Edits (MUEs)

QUESTION: Is there an appeal process for claim lines denied based on Medically Unlikely Edits (MUEs)?
ANSWER: Since claim lines are denied at Carriers and Part A/Part B Medicare Administrative Contractors (A/B MACs) processing claims with the MCS system and at Durable Medical Equipment Medicare Administrative Contractors (DME MACs) processing claims with the VMS system, MUE-based claim line denials at these contractors may be appealed. However, at FIs and A/B MACs processing claims with the Fiscal Intermediary Shared System (FISS), claims with a claim line with units of service exceeding an MUE value are returned to the provider. No claim denial occurs, and appeals are not available. Appeals should be submitted to local contractors not the MUE contractor, Correct Coding Solutions, LLC


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Medicare to bill for CPT code 96125

QUESTION: Who is authorized by Medicare to bill for CPT code 96125 (that was added under CPT effective January 1, 2008)?


ANSWER: CPT code 96125 ( standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) is designated under Medicare as an “always therapy” code. Physical therapists (PTs), occupational therapists (OTs), and speech language pathologists (SLPs) may bill this code for patients only when the patient is under a therapy plan of care. (Please note that CPT Changes: An Insider’s View 2008 suggests that when testing like that performed under 96125 is performed by a physician or a psychologist, a code from the 96101-96103 or 96118-96120 series should be reported.)



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Can hospitals use modifier –51?

QUESTION: Can hospitals use modifier –51?

ANSWER: Modifier –51 is not used by hospitals.





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