Question:
Laura Villa:
Hello Everyone,
I am fairly new to Cardio billing and I need help figuring out how to bill Medicare of Louisiana for cpt A9500. Most of the time the doctor does the nuclear stress test in the office and he is getting paid for most of the codes used (93018, 78452, J code) but the only one getting denied is the A9500 cardio lite code.
Am I supposed to be adding something to the claim in order to get this code paid as well? Is there a modifier I can use with this code?
Someone, please help!!!
Answer Thread:
Laureen:
What's the J code? And what is the place of service?
It could be the hospital is getting reimbursed for the A9500 separately
Laura Villa:
Hello,
Well sometimes the doctor does the test in a hospital outpatient setting, which would mean that the hospital gets reimbursed for the A9500 code, but he also performs the test in the office.
I believe its the J1250. Medicare has denied the A9500 for the CO-45 reason code so I'm not sure if there is something else I need to be putting on my claim for this code to get paid.
Any help would be greatly appreciated!
Laureen:
Sounds like this is a billing issue, not a coding issue.
CO-45 is an adjustment code - see your carrier's website for a definition - here is an example from Aetna https://www1.aetna.com/provider/data/COB_adjreason_grpcode_table.pdf
- Provider's charge for the rendered service(s) exceeds the Reasonable & Customary amount.
Paul A.:
Someone was asking about similar HCPCS code on the AAPC forums today and mentioned major CCI updates. It appears Radiopharmaceutical agents are now bundled into the procedure. CCI shows no modifiers allowed. Although this combo is not coming up as bundled.
Laura Villa:
Thank you everyone for their responses! Much appreciated!
Laura Villa:
Hello Everyone,
I am fairly new to Cardio billing and I need help figuring out how to bill Medicare of Louisiana for cpt A9500. Most of the time the doctor does the nuclear stress test in the office and he is getting paid for most of the codes used (93018, 78452, J code) but the only one getting denied is the A9500 cardio lite code.
Am I supposed to be adding something to the claim in order to get this code paid as well? Is there a modifier I can use with this code?
Someone, please help!!!
Answer Thread:
Laureen:
What's the J code? And what is the place of service?
It could be the hospital is getting reimbursed for the A9500 separately
Laura Villa:
Hello,
Well sometimes the doctor does the test in a hospital outpatient setting, which would mean that the hospital gets reimbursed for the A9500 code, but he also performs the test in the office.
I believe its the J1250. Medicare has denied the A9500 for the CO-45 reason code so I'm not sure if there is something else I need to be putting on my claim for this code to get paid.
Any help would be greatly appreciated!
Laureen:
Sounds like this is a billing issue, not a coding issue.
CO-45 is an adjustment code - see your carrier's website for a definition - here is an example from Aetna https://www1.aetna.com/provider/data/COB_adjreason_grpcode_table.pdf
- Provider's charge for the rendered service(s) exceeds the Reasonable & Customary amount.
Paul A.:
Someone was asking about similar HCPCS code on the AAPC forums today and mentioned major CCI updates. It appears Radiopharmaceutical agents are now bundled into the procedure. CCI shows no modifiers allowed. Although this combo is not coming up as bundled.
Laura Villa:
Thank you everyone for their responses! Much appreciated!