Billing & Coding

Use G0283 Electrical Stimulation to one or more areas for indications other than wound care, as part of a therapy plan (TENS, IFC, NMES)for medicare.

HCPCS code G0283 should be used for unattended electrical stimulation, to one or more areas for indications other than wound care. (Note: CPT code 97014 is considered invalid for Medicare for all outpatient settings and united healthcare for private practices (most other payers recognize 97014)

Claims that are denied for medical necessity must be appealed and should not be resubmitted.

If you have a claim that are denied for medical necessity you should not re-submit your claim Instead, contact your carrier to see if you can do a phone review or attach documentation supporting your appeal and send your claim in with an appeal letter. These claims must be appealed and should not be resubmitted.

You need to have a prescription on file and note the correct modifiers on your claim form stating all conditions have been met (for Medicare). I have had better results attaching the prescription to the claim, however it is not required.

Telehealth Psychiatric Service (Resource 283)

Telehealth (also known as telemedicine) is playing an ever increasing roll in the reimbursement process. Internet services continue to expand and many insurance payers/providers are now covering (paying for) telehealth services. Telepsychiatry (providing behavioral health services in a telehealth environment) has been highly successful because video conferencing makes providing psych services as realitvely simply and inexpensive process.

Effective April 1, 2014, the SI for HCPCS code Q2052 (Services, supplies, and accessories used in the home under the Medicare intravenous immune globulin (IVIG) demonstration) will change:

1)  From SI=N (Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.)

2) To SI=E (Not paid by Medicare when submitted on outpatient claims (any outpatient bill type)).

Coverage for any DMEPOS items will be considered if the place of service is:

Effective  July 1, 2014 two new HCPCS codes have been created for reporting certain drugs and biologicals and they are effective for services furnished on or after July 1, 2014.

Q9970 - Injection, Ferric Carboxymaltose, 1mg

Q9974 - Injection, Morphine Sulfate, Preservative-Free or Epidural Or Intrathecal Use, 10 mg

 

References:

NEW CODE: G9974 Injection, Morphine Sulfate, Preservative-Free or Epidural Or Intrathecal Use, 10 mg.

  • HCPCS code J2275 (Injection, morphine sulfate (preservative-free sterile solution), per 10 mg) will be replaced with HCPCS code Q9974 effective July 1, 2014.

The SI for HCPCS code J2275 will change to E, “Not Payable by Medicare,” effective July 1, 2014.

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