BILLING A4556 with 93000 and billing 99393 with 99213,99401 cpt codes

Procedure code and Description

A4556 Electrodes (e.g., Apnea monitor), per pair


CODING GUIDELINES 

A transcutaneous electrical nerve stimulator (TENS) (E0720, E0730) is a device which utilizes electrical current delivered through electrodes placed on the surface of  the skin to decrease the patient's perception of pain by inhibiting the transmission of afferent pain nerve impulses and/or stimulating the release of endorphins. A TENS  unit must be distinguished from other electrical stimulators (e.g., neuromuscular stimulators) which are used to directly stimulate muscles and/or motor nerves.

A TENS supply allowance (A4595) includes electrodes (any type), conductive paste or gel (if needed, depending on the type of electrode), tape or other adhesive (if needed, depending on the type of electrode), adhesive remover, skin preparation materials, batteries (9 volt or AA, single use or rechargeable), and a battery charger  (if rechargeable batteries are used). Codes A4556 (Electrodes, [e.g., apnea monitor], per pair), A4558 (Conductive paste or gel), and A4630 (Replacement batteries, medically necessary TENS owned by patient) are not valid for claim submission to the DMERC. A4595 should be used instead. For code A4557, one unit of service is for lead wires going to two electrodes. If all the lead wires of a 4 lead TENS unit needed to be replaced, billing would be for  two units of service.

There should be no billing and there will be no separate allowance for replacement electrodes (A4556), conductive paste or gel (A4558), replacement batteries (A4630), or a battery charger used with a TENS unit. Other supplies, including but not limited to the following, will not be separately allowed: adapters (snap, banana, alligator, tab, button, clip), belt clips, adhesive  remover, additional connecting cable for lead wires, carrying pouches, or covers. Suppliers should contact the Pricing, Data Analysis and Coding (PDAC) Contractor for guidance on the correct coding of these items


Can physician bill CPT 99285 and CPT 93042?

Ans : Yes you can.

Note : CPT codes describe what services have been performed. The Evaluation and Management (E/M) codes 99281-99285 are the codes for cognitive services most commonly utilized by and familiar to emergency physicians.


Can ASC use outside labs for waive test

Ans : No we can’t. If we billed it won’t be paid.


Can i bill A4556 with 93000?


Ans : We can’t.

Note :  Because A4556 included with CPT 93000. It will not reimburse separately it will be denied as Bundled or inclusive.


Can we bill 99393 with 99213 and 99401 and 99420

Ans : We can bill together, but we would get reimbursement for any one CPT.




Updates to Claims Processing Edits and Reimbursement Policies

Bundled Services and Supplies

As we advised in the July 2014 Network Update, we are continuing to review and add HCPCS Level II temporary “S” codes to the always bundled services edit in ClaimsXten. Unless there are specific, specialized contracts or criteria for a provider to report their services using a HCPCS Level II temporary “S” code, Anthem will consider “S” codes to be always bundled codes. Therefore, effective with dates of service on or after March 1, 2015, these additional “S” codes S0201, S0209, S0215, S0265, S0320, S0390, S0618, S3650, S4026, S8185, S9001, S9025, S9447, S9982, and S9991 will not be eligible for reimbursement as described in Section 1 of the Bundled Services and Supplies policy.

Additionally, as HCPCS Level II codes A4556 – (electrodes) and A4557 – (lead wires) are included in A4595 – (electrical stimulator supplies), effective with dates of service on or after March 1, 2015, codes A4556 and A4557 will not be separately reimbursed on the same date of service and/or within 30 days of code A4595. [Please refer to reimbursement policy: Bundled Services and Supplies


Frequency Editing

The Frequency Editing Policy will be updated effective for dates of service on or after March 1, 2015 to add a limit of 2 pair per 30 days for HCPCS Level II codes A4556 – (electrodes), and a limit of 4 pairs per 365 days for A4557 – (lead wires).


RESPONDENT’S POSITION SUMMARY

Respondent’s Position Summary: “CPT 95911 01/05/2015 – Provider billed $355.59 the provider was paid $355.59 as noted under ICN 26150121557300 on 01/22/2015 check # 240437426…CPT A4556 01/05/2015 – Provider billed $25.00 the provider was paid $0.00. Supplies to perform the billed diagnostic studies are not separately reimbursed. A4556 is included in the payment for 95886 & 95911.”



Issues

1. Is the requestor entitled to additional reimbursement for CPT code 95911?

2. Is the benefit for HCPCS code A4556 included in the benefit of another service billed on the disputed date? Is
the requestor entitled to reimbursement for HCPCS code A4556?

2. According to the explanation of benefits, the respondent paid $0.00 for HCPCS code A4556 based upon reason code “V163.”

HCPCS Code A4556 is defined as “Electrodes (e.g., apnea monitor), per pair.” Per Medicare guidelines, Transmittal B-03-020, effective February 28, 2003 if Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) HCPCS codes are incidental to the physician service, it is not separately payable. A review of the submitted documentation does not support a separate service to support billing HCPCS code A4556. As a result, additional reimbursement is not recommended.


NMES and TENS Supplies

Supply codes A4556, A4557, or A4595 may be reimbursed with documentation of a client-owned device and without prior authorization. Additional documentation such as the purchase date, serial number, and purchasing entity of the device may be required.

Supplies for purchased devices are limited as follows:

• If additional electrodes are required, procedure code A4556 may be considered for reimbursement at a maximum of 15 per month.

• If additional lead wires are required, procedure code A4557 may be considered for reimbursement at a maximum of 2 per month.

• Procedure code A4595 is limited to 1 per month. Supplies are included in the rental and will not be reimbursed separately.


All supplies (lead wires, electrodes, paste or gel, batteries, battery chargers, pouches, and carryingcases) are considered content of purchase of new codes E0720 and E0730. Lead wire, electrodes, and paste or gel may not be billed separately for the first 30 days after purchase of a TENS unit. Code A4556 is limited to no more than one pair (one unit equals one pair) every six months for a two-lead unit. If using a four-lead unit, two pairs are allowed every six months. Code A4557 is limited to no more than one pair (one unit equals one pair) every 12 months for a two-lead unit. If using a four-lead unit, two pairs are allowed every 12 months. Code A4558 is limited to no more than one unit (one ounce equals one unit) every six months for a two-lead unit. If using a four-lead unit, two units (one ounce equals one unit) are allowed every six months. The type of electrodes currently being used must require the use of paste or gel.



HCPCS Description Jurisdiction

A4360-A4435 Urinary supplies If provided in the physician’s office for a temporary  condition, the item is incident to the physician’s service & billed to the local carrier. If provided in the physician’s office or other place of service for a permanent condition, the item is a prosthetic device & billed to the DME MAC.

A4450-A4456 Tape; adhesive remover Local carrier if incident to a physician’s service (not separately payable), or if supply for implanted prosthetic device. If other, DME MAC.

A4458 Enema bag DME MAC

A4461-A4463 Surgical dressing holders Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC.

A4465-A4466 Non-elastic binder and elastic garment DME MAC

A4470 Gravlee jet washer Local carrier

A4480 Vabra aspirator Local carrier

A4481 Tracheostomy supply Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC.

A4483 Moisture exchanger DME MAC

A4490-A4510 Surgical stockings DME MAC

A4520 Diapers DME MAC

A4550 Surgical trays Local carrier

A4554 Disposable underpads DME MAC

A4556-A4558 Electrodes; lead wires; conductive paste service Local carrier if incident to a physician’s (not separately payable). If other, DME MAC.

A4559 Coupling gel Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC.

A4561-A4562 Pessary Local carrier

A4565 Sling Local carrier

A4566 Shoulder abduction restrainer DME MAC

A4570 Splint Local carrier

A4575 Topical hyperbaric oxygen chamber, disposable DME MAC

A4580-A4590 Casting supplies & material Local carrier

A4595 TENS supplies Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC.

A4600 Sleeve for intermittent limb compression device DME MAC

A4601 Lithium Ion battery for nonprosthetic use DME MAC

A4604 Tubing for positive airway pressure device DME MAC

A4605 Tracheal suction catheter DME MAC

A4606 Oxygen probe for oximeter DME MAC

A4608 Transtracheal oxygen catheter DME MAC

A4611-A4613 Oxygen equipment batteries and supplies DME MAC

A4614 Peak flow rate meter Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC.

A4615-A4629 Oxygen & tracheostomy supplies Local carrier if incident to a physician’s service (not separately payable). If other, DME MAC. A4630-A4640 DME supplies DME MAC

1 comment:

Anonymous said...

Can I bill any of the following A6411, a4558,a4556 with the cpt codes of 95950 and/or 92275?

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