Credit Balance Report - CMS 838 (R3)

Chapter VII: Online Reports View Submenu (04) Credit Balance Report - CMS 838 (R3) Purpose Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit [...]

Do hospitals bill a different CPT to receive compensation? Usually, the doctor’s office will bill 27096 on 1500 and we bill G0260 for facility claim (UB-04). Will PA need to have both CPTs? 27096 on Medicare fee schedule receives no compensation?

There is a contrast shortage. Use may not be an option.

Do we use the same billing guideline for 64550 and 20551?

If using steroid during diagnostic is that when the 12-month clock start?

If a patient fails an initial diagnostic or therapeutic injection is there a certain criteria that must be fulfilled prior to considering it again, such as duration since the last injection (like over a year ago) or change in symptom character or location?

Can the patient can have two diagnostic SIJI and then four therapeutic SIJI within a 12-month rolling period for a total of six per year?

What is the time period between a therapeutic injection and repeat diagnostic, if the therapeutic injection has not been performed for an extended period? At this point, does diagnostic need to be repeated?

What is the purpose of a diagnostic injection, to select patients for fusion surgery only? Also, with diagnostic injections using anesthetic and steroid, what is the duration of effect expected for the steroid?

Do we use the KX modifier on facility charges for the ASC?

It does not make sense to use steroids during a diagnostic injection. Please explain.

Does anti-inflammatory steroid as named in the diagnostic injection mean an injected NSAID or corticosteroid?

What is the time period between a therapeutic injection and repeat diagnostic? If the therapeutic injection has not been performed for an extended period of time does diagnostic need to be repeated?

When will this go into effect?

Are there more studies going on to get sacroiliac joint radiofrequencies to be a covered benefit?

Can SIJ ligaments be included in a therapeutic injection?

CPT code 27096 includes “Image guidance,” what’s the necessary required documentation? Does the physician still need permanently recorded images? Because the fluoroscopy/CT is bundled into the procedure and therefore the fluoroscopy/CT will not be separately reported, would the image guidance in the Radiology section regarding guidance procedures still apply?

What is the requirements for diagnostic injections? Are two required?

Will RFA be an acceptable treatment?

What is the expected duration of steroid effect for diagnostic injection?