Hospice Top Claim Errors

Do you see the same rejections and return to provider over and over? Do you know how to correct the most common errors and more importantly how to avoid them in the future? In this session we’ll review the most common reason codes assigned to [...]

How can provider access post injection pain after the injection?

How many injections per calendar year?

Can SIJ ligaments be included in a therapeutic injection?

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

Many patients have degeneration throughout the spine does that justify need for multiple procedures in same session?

Will prior authorization be required?

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

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?

Will RFA be an acceptable treatment?

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?

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?

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?

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?

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

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

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?

When billing for waste on a single use vial would you round units up or down for a half unit?

When billing an unclassified drug code such as J3490, are the units of service on the claim always equal to one?

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

J3357, Ustekinumab (Stelara) is listed on the Self-Administered Drug Exclusion List: Medical Policy Article A53021, and it says “acceptable”. Does this mean it is excluded or not?

What is the proper way to submit professional physician claim with multiple NDC numbers for the same drug code?

What is the correct way to bill an unlisted drug or biological?

How do I bill a bilateral joint injection and HCPCS J1040 for two units?

Is the shingles vaccine covered by Medicare?

Does Medicare Part B make payment for the unused portion of a multi-dose vial of a drug/biological?

Why is radiofrequency ablation (RFA) noncovered?

Is the GY modifier required on the drug code and the administration code for noncovered self-administered drugs?

Don't use G0260 only applies to POS 49? So, regardless of facility type, G0260 no longer needs to be used? And Is G0260 still fine to bill for an ASC or will they now just have 27096 for facility & should be billed with POS 24 and bill G0260 for our SIJI on the facility side?

Does the waste with the JW modifier appended always go on the second line regardless of the billed amount? For example, the billed amount for the waste is higher than the administered amount.

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

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?

For patients who are already receiving treatment do they need to repeat diagnostic procedures under the new policy?

Can sacroiliac joint injections be performed bilaterally?

If SIJ is injected on right and then determined to inject the left side in another session does that count as bilateral?

Will there be a minimal amount of time between SI joint steroid injections?

When does a pain scale or functional assessment need to be done?

We are in a group of eight physicians. What if the patient saw a different physician in clinic and a different physician is doing injection. Is that okay?

What should be done if patient does not want to continue conservative treatment?

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

We receive referrals for an injection with detailed chart notes, does our provider need to see and examine the patient again?

Can CRNAs perform these procedures?

Do all established drug HCPCS codes require the dosage amount in its description on the claim?

How do we report unilateral vs. bilateral injections?

Have the payable diagnoses for IVIG and Rituximab changed? I don’t see all of the previously payable diagnoses in the applicable drug local coverage determinations (LCDs) and articles.

When did this go into effect?

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

If a SIJI is performed and a biological agent is added to the injected will the injection still be covered?

Can SIJIs be performed under sedation? How about monitored anesthesia care (MAC)? Is “twilight” allowed?

Are the radiofrequency ablations allowed now until 3/20/2023, or are already noncovered?

Can chemotherapy be split into two doses on two different dates of service if the patient was unable to complete a full dose in one day? For example, the patient's port was not functioning properly.

Are unclassified drug codes included in average sales price (ASP) files?

Can Medicare Part B providers who bill on the professional CMS-1500 claim form, and electronic equivalent, bill unclassified drug code C9399?

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