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DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES HEALTH RESOURCES DIVISION Outpatient Prospective Payment System Billing Guide November 2005. OPPS. Montana Medicaid uses Medicare’s Outpatient Prospective Payment System since August 2003

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DEPARTMENT OF

PUBLIC HEALTH AND HUMAN SERVICES

HEALTH RESOURCES DIVISION

Outpatient Prospective Payment System

Billing Guide

November 2005


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OPPS

  • Montana Medicaid uses Medicare’s Outpatient Prospective Payment System since August 2003

  • Medicaid uses a Montana specific conversion factor ($47.75) and updates quarterly along with Medicare

  • Medicaid deviates from Medicare in some cases (I.e. therapies, obstetric observation, inpatient only)

  • Payment is lower of OPPS payment (fees and APCs) or your charges

    • Charge cap does not apply to line level

  • Appropriate and accurate coding is the key to proper reimbursement under OPPS


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OPPS/APC

  • Some services paid by fee schedule

    • Therapies (speech, physical, occupational)

    • Laboratory

    • Diagnostic

  • If there is no APC, Medicare fee or Medicaid fee (RBRVS), some services pay hospital specific outpatient cost to charge ratio

    • Drugs and Biologicals

    • Devices

  • Ambulatory Payment Classification

    • Payment based on CPT/HCPCS codes

    • Status Indicator tells the method of payment

    • Each service is eligible for potential payment

      • Emergency room

      • Treatment Room

      • Provider-based clinic

      • Cancer care

      • Ambulatory Surgery

    • Capture every charge every time to insure payment


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Coding

  • Your claim should tell the story of what happened to this patient.

    • Why was he there?

    • What was done to him while in your care?

    • What supplies/products/devises/drugs where used or given?

    • Who provided the care to this patient

    • Can I look at your claim and know what took place for this patient?


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APC Status Indicators

  • C – Inpatient only services

  • G – Drugs & biologicals paid by report (hospital specific outpatient cost to charge ratio)

  • H – Devices paid by report

  • K – Drugs and biologicals paid by APC

  • M – Paid by a Medicaid specific fee or not a covered service (fee schedule will show as not allowed)

  • N – Service is bundled into an APC (If all your codes are N on your claim, your claim will pay at zero)


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APC Status Indicators (con’t)

  • Q – Lab fee schedule (60% for non-sole community, 62% for sole community)

  • S – Significant procedure paid by APC that the multiple procedure discount DOES NOT apply to

  • T – Significant procedure paid by APC that the multiple procedure discount DOES apply to

  • V – Medical visits in the clinic, critical care or emergency department (includes codes for direct admits)

  • X – Ancillary services paid by their own APC

  • Y – Medicaid fee for therapies (90% of RBRVS office fee)


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0-Bundled code pays zero

1-Priced using QMB Pricing

2-Lab panel bundled

4-Priced using RBRVS

5-Anesthesia pricing

7-APC priced

8-APC priced

9-Lower level screening fee

A-Manually priced

B-By report

C-Maximum fee

D-Percent of charges

E-Reimbursement Rate

G-Billed Charges

H-Denied

I-Medicare Coins and deductible

K-Medicare allowed amount

M-Medicare prevailing

P-DRG

R-DRG w/cost outlier

U-DRG priced by proration

V-Mid-level priced

Z-ATP Bundled

Allowed Charge Source Codes• Allowed Charge Source codes tell MMIS how to price a claim-this is what PR sees


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HOSPITAL OUTPATIENT MODIFIERS

Medicaid uses Medicare Outpatient Claim Edits

Medicaid does not allow reporting separate codes for related services when there is 1 code that includes all related services

Medicaid does not allow breaking out bilateral procedures when 1 code is appropriate


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OPPS Modifiers

  • The paper UB-92 can accommodate 1 modifier

  • The 837 can accommodate 4 modifiers

  • Always report the payment modifier 1st as ACS processes the claim using only the first modifier


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OPPS Modifiers

  • Modifiers are used to indicate that:

    • A service was provided more than once

    • A bilateral procedure was performed

    • A service or procedure has been increased or reduced

    • Only part of a service was performed

    • A distinct procedure was performed

    • A service was discontinued


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Common Outpatient Modifiers

  • Level I Modifiers

  • 25 – significant separate E&M service

  • 27 – multiple E&M same day

  • 50 – bilateral procedure

  • 52 – reduced services

  • 58 – staged or related service

  • 59 – distinct procedure

  • 73 – procedure terminated prior to anesthesia

  • 74 - procedure terminated after anesthesia

  • 76 – repeat procedure by same physician

  • 77 – repeat procedure by another physician

  • 91 – repeat clinical diagnostic lab test


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Modifiers More Modifiers

  • Level II Modifiers

  • LT – left side

  • RT – right side

  • LC – left circumflex coronary artery

  • LD – left anterior descending coronary artery

  • RC – right coronary artery

  • GN – service under speech language pathology plan of care

  • GO - service under occupational therapy plan of care

  • GP - service under physical therapy plan of care

  • TC - technical component


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Modifiers Approved for Hospital Outpatient Use

  • 25-significant, separately identifiable E&M service by the same physician on the same day

  • Only used with E&M codes 92002-92014, 99201-99499, G0101, G0175 & G0264

  • The Outpatient Code Editor (OCE) only requires the modifier if procedures with a status of “T” or “S” are present


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Modifiers Approved for Hospital Outpatient Use

  • 27-multiple outpatient hospital E&M encounters on the same day

  • Only used with E&M codes 92002-92014, 99201-99499, G0101, G0175 & G0264

  • Use on the second E&M code for the same date of service


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Modifiers Approved for Hospital Outpatient Use

  • 50 – Bilateral Procedure

  • Used to report bilateral procedures performed at the same operative session

  • Bill one line with the procedure code

  • RT & LT are not used when 50 is used

  • DO NOT use if the code description indicates “bilateral”


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Modifiers Approved for Hospital Outpatient Use

  • 59 – Distinct Procedural Service

  • Used to report two procedures that are not normally reported together

  • Different session or patient

  • Different procedure or surgery

  • Different site or organ system

  • Separate incision

  • Separate injury that is not normally encountered or performed by the same physician on the same day


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Modifiers Approved for Hospital Outpatient Use

  • 76- Repeat procedure by same physician

  • 77- Repeat procedure by another physician

  • Use 76 to indicate that a procedure or service was repeated in the same session on the same day by the same physician

  • Use 77 to indicate that a procedure performed by one physician had to be repeated in a separate session on the same day by another physician

  • Attach modifier to the second procedure

  • Enter the number of times the procedure was repeated in the unit column

  • Can be used for procedures performed by the physician or performed by the technician (e.g., EKGs)


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Modifiers Approved for Hospital Outpatient Use

  • 91- Repeat Clinical Diagnostic Lab

  • Use when the same lab test is repeated on the same day to obtain subsequent test results

  • Do not use when tests are re-run to confirm initial results, when there were testing problems with specimens or equipment or for any other reason when a one-time result is all that is required

  • Attach modifier to the second lab test

  • Enter the number of times the subsequent lab test was done in the unit column


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Modifiers Approved for Hospital Outpatient Use

  • TC- Technical Component

  • Under certain circumstances, a charge may be made for the technical component alone. Under those circumstances adding modifier TC to the usual procedure number identifies the technical component charge

  • Note: The TC modifier should not be appended to procedure codes that represent the technical component (example: 93005)

  • Do not use this modifier to designate the UB facility portion of provider based claim


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Observation Services

  • Four qualifying conditions for payment

  • Chest Pain

  • Asthma

  • Congestive Heart Failure

  • Obstetric Complications (pre-delivery complications)

  • Starting April 1, 2005, the qualifying diagnosis must be in either:

  • Admitting diagnosis (FL 76); or

  • Principal diagnosis (FL 67)


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Observation Services

  • Medicare/Medicaid Rules

  • OBS services must be reasonable and necessary

  • There must be a physician order prior to initiation

  • Physician order must be by a physician with privileges

  • Physician must be actively directing patient care

  • During OBS, patients must be actively assessed

  • Observation is not a substitute for inpatient

  • Observation is not for continuous monitoring

  • Observation is not for patients waiting for NH placement

  • Observation is not to be used for convenience or as routine prior to IP status


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Observation Services

  • Four ways to reimbursement

  • Direct admit for qualifying condition pays observation (APC 339-$342.11)

  • ED, clinic or critical care admit for qualifying condition pays observation (APC 339-$342.11)

  • Direct admit for non-qualifying condition pays APC 600 (Low Level Clinic Visit-$43.13)

  • ED, clinic or critical care admit for a non-qualifying condition pays APC 600 (Low Level Clinic Visit-$43.13)

  • Also pays any other separately payable codes on the claim


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Qualifying Observation Requirements

  • Chest Pain

  • Required Diagnosis: 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 786.05, 786.50, 786.51, 786.51, 786.59

  • These diagnostic tests are NO LONGER REQUIRED: 2 sets of cardiac enzymes (either two CPK 82550, 82552, or 82553) or two troponin (84484 or 84512) and two sequential electrocardiograms

  • Asthma

  • Required Diagnosis: 493.01, 493.02, 493.11, 493.12, 493.21, 493.22, 493.91, 493.92

  • These diagnostic tests are NO LONGER REQUIRED: A breathing capacity test (94010) or pulse oximetry (94760 or 94761 or 94762)


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Qualifying Observation Requirements

  • Congestive Heart Failure

  • Required Diagnosis: 391.8, 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.33, 428.30, 428.31, 428.31, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9

  • These diagnostic tests are NO LONGER REQUIRED: A chest x-ray (71010, 71020 or 71030) and an electrocardiogram (93005) and pulse oximetry (94760, 94761, or 94762)


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Qualifying Observation Requirements

  • Obstetric Complications (Pre-delivery)

  • Required Diagnosis:

  • 640.00, 640.03, 640.80, 640.83, 640.90, 640.93, 644.00, 644.03, 644.10, 644.13, 630.00, 631.00,

  • 641.03, 641.13, 641.23, 641.30, 641.33, 641.83, 641.93, 642.03, 642.13, 642.23, 642.33, 642.43,

  • 642.50, 642.53, 642.60, 642.63 642.70, 642.73, 642.93, 643.00, 643.03, 643.10, 643.13, 643.20,

  • 643.23, 643.80, 643.83, 643.90, 643.93, 644.20, 645.13, 645.23, 646.03, 646.10, 646.13, 646.20,

  • 646.23, 646.33, 646.43, 646.53, 646.60, 646.63, 646.70, 646.73, 646.80, 646.83, 646.93, 647.03,

  • 647.13, 647.23, 647.33, 647.43, 647.53, 647.63, 647.83, 647.93, 648.03, 648.13, 648.23, 648.33,

  • 648.43, 648.53, 648.63, 648.73, 648.83, 648.93, 651.03, 651.13, 651.23, 651.33, 651.43, 651.53,

  • 651.63, 651.83, 651.93, 652.03, 652.13, 652.23, 652.33, 652.43, 652.53, 652.63, 652.73, 652.83,

  • 652.93, 653.03, 653.13, 653.23, 653.33, 653.43, 653.53, 653.63, 653.73, 653.83, 653.93, 654.03,

  • 654.13, 654.23, 654.33, 654.43, 654.53, 654.63, 654.73, 654.83, 654.93, 655.03, 655.13, 655.23,

  • 655.33, 655.43, 655.53, 655.63, 655.73, 655.83, 655.93, 656.03, 656.13, 656.23, 656.33, 656.43,

  • 656.53, 656.63, 656.73, 656.83, 656.93, 657.03, 658.03, 658.13, 658.23, 658.33, 658.43, 658.83,

  • 658.93, 659.03, 659.13, 659.23, 659.33, 659.43, 659.53, 659.63, 659.73, 659.83, 659.93, 660.03,

  • 660.13, 660.23, 660.33, 660.43, 660.53, 660.63, 660.73, 660.83, 660.93, 661.03, 661.13, 661.23,

  • 661.33, 661.43, 661.93, 662.03, 662.13, 662.23, 662.33, 663.03, 663.13, 663.23, 663.33, 663.43,

  • 663.53, 663.63, 663.83, 663.93, 665.03, 665.83, 665.93, 668.03, 668.13, 668.23, 668.83, 668.93,

  • 669.03, 669.13, 669.23, 669.43, 669.83, 669.93, 671.03, 671.13, 671.23, 671.33, 671.53, 671.83,

  • 671.93, 673.03, 673.13, 673.23, 673.33, 673.83, 674.03, 675.03, 675.13, 675.23, 675.83, 675.93,

  • 676.03, 676.13, 676.23, 676.33, 676.43, 676.53, 676.63, 676.83, 676.93, 792.3, 796.5, V28.0,

  • V28.1, V28.2, V61.6


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Billing for Obstetric Observation

  • Direct Admit for Qualifying Condition

  • Revenue Code 762 with G0263

    • Units = 1, charges are necessary on this line (even $1)

  • DO NOT BILL USING G0244

  • DO NOT USE G0263 on a non-direct admit (claims with 510 or 450 revenue codes)

  • Must have qualifying diagnosis for Obstetric Complications (pre-delivery complications)

  • If qualifying condition is obstetric complications, you must also have a 2nd revenue code 762 with 99234, 99235,or 99236

    • Units = 1-72, must have actual charges on this line


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Billing for Obstetric Observation

  • ED, Clinic or Critical Care Admit for Qualifying Condition

  • DO NOT BILL USING G0244

  • Must have qualifying diagnosis code for Obstetric Complications (pre-delivery complications)

  • Must bill either an ED visit with rev code 45X or a clinic visit with rev code 51X or critical care visit

    • Must use modifier 25 with the E&M code for the visit

  • If qualifying condition is obstetric complications, you must also have a 2nd revenue code 762 with 99234, 99235 or 99236

    • Units = 1-72, actual charges are necessary on this line


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Billing for Other Covered Observation Services

  • Direct Admit for Qualifying Condition

  • Revenue Code 762 with G0263

    • Units = 1, charges are necessary on this line (even $1)

  • Revenue Code 762 with G0244

    • Units = 8-72, actual charges must be on this line

  • Must have Medicare required tests for Chest Pain, Asthma or Congestive Heart Failure under appropriate revenue codes or must have qualifying diagnosis for Obstetric Complications

  • G0244 is the code that drives payment. G0244 is not payable if billed with services that have a status indicator of “T” (other than 90780)

  • If qualifying condition is obstetric complications, you must also have a 3rd revenue code 762 with 992XX (99217-99220 or 99243-99236)

    • Units = 1, charges are necessary in this field (even $1)


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Billing for Other Covered Observation Services

  • ED, Clinic or Critical Care Admit for Qualifying Condition

  • Revenue Code 762 with G0244

    • Units = 8-72, actual charges MUST be on this line

  • Must have Medicare required tests for Chest Pain, Asthma or Congestive Heart Failure under appropriate revenue codes or must have qualifying diagnosis code for Obstetric Complications

  • Must bill either an ED visit with rev code 45X or a clinic visit with rev code 51X or critical care visit – DO NOT BILL G0263

    • Must use modifier 25 with the E&M code for the visit

  • If qualifying condition is obstetric complications, you must also have a 2nd revenue code 762 with 992XX (99217-99220 or 99243-99236)

    • Units = 1, charges are required on this line (even $1)

  • G0244 is the code that drives payment. G0244 is not payable if billed with services that have a status indicator of “T” (other than 90780)


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Billing for Other Covered Observation Services

  • Direct Admit for Non-Qualifying Condition

  • Revenue Code 762 with G0264

    • Units = 1 (one), actual charges MUST be on this line

  • Must have 762 with 992XX (99217-99220 or 99243-99236) for all non-qualifying conditions

    • Units = hours, charges are necessary (even $1)

  • If there are other services on the claim with status codes of “S” or “T” you must use modifier 25 with G0264


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Billing for Other Covered Observation Services

  • ED, Clinic or Critical Care Admit for Non-Qualifying Condition

  • Revenue Code 45X or 51X with the appropriate CPT code

    • Units = 1 (one), actual charges MUST be on this line

  • Must have 762 with 992XX (99217-99220 or 99243-99236) for all non-qualifying conditions

    • Units = hours, charges are necessary on this line (even $1)

  • The OCE requires modifier 25 if procedures with a status of “T” or “S” are present


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Outpatient Lab

  • Clinical diagnostic laboratory services including automated multichannel test panels (commonly referred to as "ATPs") and lab panels are reimbursed on a fee basis

  • The fee for a clinical diagnostic laboratory service is the lesser of the provider's charge or the applicable percentage of the Medicare fee schedule as follows:

    • 60% of the prevailing Medicare fee schedule where a hospital laboratory acts as an independent laboratory, i.e., performs tests for persons who are non-hospital patients;

    • 62% of the prevailing Medicare fee schedule for a hospital designated as a sole community hospital or

    • 60% of the prevailing Medicare fee schedule for a hospital that is not designated as a sole community hospital


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Outpatient Lab

  • For clinical diagnostic laboratory services where no Medicare fee has been assigned, the fee is 62% charges for a hospital designated as a sole community hospital or 60% of charges for a hospital that is not designated as a sole community hospital

  • Specimen collection is reimbursed $3.00 for drawing a blood sample through venipuncture or for collecting a urine sample by catheterization.

    • No more than one collection fee is allowed for each patient visit, regardless of the number of specimens drawn.

  • Crossover claims are not subject to lab panel bundling logic


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Outpatient Lab Bundling

  • If a claim has procedure codes that bundle to multiple lab panels, the program will bundle the codes into a regular panel (if all the codes are present)

    • The remaining codes will bundle into an ATP

  • The OB panel (80055) pays a fee schedule price of $44.68 for both non-sole and sole community hospitals

  • The General Health panel (80050) pays a fee schedule price of $56.77 for both non-sole and sole community hospitals

  • Lower of pricing applies to bundling.

    • If the total billed charge for all bundled lines on the claim is less than the allowed charge for the lab panel, the claim pays the billed charge


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Outpatient Lab Reimbursement

  • Allowed Charge Source codes tell ACS and the Department how the system reimbursed your lab claim

    • 2 is Panel bundled

    • 7 or 8 are APC

    • A is manually priced

    • M is Medicare fee

    • Z is ATP bundled

  • If the allowed chg source code on the line is 7, 8 or A the line is excluded from bundling

  • If the line has a modifier of 76 or 91 the line is excluded from bundling

  • Bundling only occurs on procedures with the same date of service


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Outpatient Lab Reimbursement

  • For multi-procedure panels, the highest number of tests is priced first.

  • For example, 80438 is 84443x3 and 80439 is 84443x4. These lines would group to panel 80439 if 4 tests are present rather than panel 80438 and 1 individual 84443.

  • System logic always bundles to the highest level.

  • If the procedure code is a component of a Panel or ATP, the system prices to APCs 1st, Lab Panel 2nd , ATPs 3rd and individual fees last.


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Outpatient Lab Billing

  • You need to bill one line with the procedure code and multiple units. If you bill the same code on more than 1 line, your remittance advice will show the bundled payment on the 1st line and will show the additional lines as denied (even though they did not)

  • Lines that have been bundled will show reason code 042 and remark code M75

  • The remittance advice will NOT show the panel or ATP code to which the lines bundled

  • The current remittance advice shows revenue codes for UB-92 claims, it does not display the procedure codes that bundled


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Tidbits

***


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Provider-Based Billing

  • Claims are billed for all of your provider-based facilities and clinics similar to how you would bill a claim in the Emergency Department

  • There is a UB and a 1500 for each billable visit

    • 1500 claim must have place of service “22” outpatient

    • UB claim uses revenue code 510 for the facility side of the office visit

    • All other services are billed on the UB except procedures that the doctor or midlevel performed (10021 to 69990)

    • If you cannot bill a 1500 (such as for a global) you cannot bill a UB and visa-versa

    • DO NOT BILL TC on the facility claim unless it is a technical component only code you would normally use TC for


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Provider Based Billing Issues

  • Obstetrics

    • Billing for complete service, antepartum, delivery and postpartum

      • Bill as usual which means a global bill with POS 21 on the 1500 side and delivery paid as a DRG on the UB side

    • Billing for incomplete services, antepartum or postpartum

      • Bill appropriate code for number of visits on 1500 and UB.

      • Codes such as 59425 are not turned on for facility side so bill a matching E&M on the UB side

  • VFC

    • Where there is an E&M

      • Bill E&M and administration code on the 1500 with POS 22, bill E&M and injectibles on UB

    • Where there is an not an E&M

      • Bill administration code with modifier SL and the VFC code on the 1500 with POS 22, bill administration code on the UB, SL does not apply on the UB side


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ED Definitions

  • “Emergency Medical Condition” means

  • A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:

    • Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

    • Serious impairment to bodily functions; or

    • Serious dysfunction of any bodily organ or part; or


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More ED definitions

  • That there is inadequate time to effect a safe transfer to another hospital before delivery; or

  • With respect to a pregnant woman who is having contractions:

    • That transfer may pose a threat to the health of safety of the woman or the unborn child.

  • Some intoxicated individuals may meet the definition.

  • Individuals expressing suicidal or homicidal thoughts or gestures, if determined dangerous to self or others, would meet the definition.


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Common Claim Edits

  • 102 – Duplicate claim

  • 112 – A readmission has been detected

  • 119 – Claim is for a potentially unbundled service

  • 120 – Date of service is more than 365 days from date received

  • 215 – Claim should pay by APC or OPPS but system could not group. These hit for 4 reasons:

    • Invalid bill type (usually you see 851 which should be 131)

    • Bad date- the span date doesn’t match the line dates

    • There is no APC to group to (department boo-boo)

    • Revenue code 636 is used wrong-this rev code can only be used for RX or vaccination codes, not for the injections

  • 280 (physician claim) - diagnosis code or procedure code is not on emergent list

  • 335 – Procedure code requires review (unlisted code)


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Common Claim Edits

  • 342 – Diagnosis code requires a review (these are almost always V codes)

  • 343 – Diagnosis code may not be a covered service

  • 345 – Sterilization review

  • 347 – Hysterectomy review

  • 370 – Abortion review

  • 371 – DRG = 468 (this DRG pays % of charges so is always reviewed for correct coding) this means that there was a procedure on the claim that was not related to the main diagnosis and procedures

  • 460 – Claim requires a prior authorization


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Common Claim Edits

  • 472 – This exception will post when the PASSPORT provider number is missing or invalid

  • 487 – This edit will fail when the client is a Team Care client and the Team Care provider did not submit the claim or did not refer the client and the service requires PASSPORT approval

  • 905 – Line dates of services are inconsistent with the header level dates of service or the line level date of service is blank (usually see on bundled claims)

  • 920 – Diagnosis code and procedure don’t match- this means that a claim hit before or after the new quarterly grouper was installed and a diagnosis code on the claim now needs a fifth digit or is invalid or the provider used an invalid diagnosis code

  • 928 – Inpatient only services performed in an outpatient setting-needs review to determine if appropriate

  • 929 – E&M code on the same date as a surgical or significant procedure without modifier 25 or 27 present on the E&M code (must be on the E&M code – not on the code with a SI of T or S)


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The ICN

  • Format: R YY JJJ MM BBB SSSSSS

    • R = Type of medium on which claim came into system

      • 0=paper

      • 2=electronic

      • 4=system generated (usually an adjustment)

    • YY = Year

    • JJJ = Julian Date

    • MM=Microfilm machine number

      • 00=electronic

      • 11=paper claims

      • 22=system generated


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More ICN

  • BBB=Batch range

    • 100 and 900=pharmacy

    • 200=HCFA 1500

    • 300=UB92 Inpatient

    • 350=UB92 outpatient

    • 375=UB92 Laboratory

    • 400=Nursing Home

    • 500=Dental

    • 600=Institutional Crossover

    • 700=Professional Crossover (799=electronic x-over)

    • 800=Adjustments

  • SSSSSS=Sequence Number


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Resources

  • www.mtmedicaid.org – THIS IS YOUR BEST RESOURCE!!

  • www.cms.hhs.gov/providers/hopps/cciedits/

  • www.cms.hhs.gov/providers/hopps Addendums A & B

  • www.cms.hhs.gov/manuals/transmittals/

  • Program Memorandum Transmittal A-01-80

  • Program Memorandum Transmittal A-03-066

  • Medicare Part A Hospital Bulletin 905

  • Medicare Part A Hospital Bulletin 1187

  • Medicare Part A Hospital Bulletin 1149

  • Medicare Part A Hospital Bulletin 1242

  • Medicare Part A Hospital Bulletin 1313

  • Med-Manual §3112.8 Outpatient Observation Services

  • Transmittal R404CP

  • Medlearn Matters Article MM3610


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Contacts

  • Debra Stipcich, Transplant and PPS Hospital Program Officer; (406) 444-4834; [email protected]

  • Rena Steyaert, Claims Resolution Specialist; (406) 444-7002; [email protected]

  • ACS, Inc. Provider Relations; (800) 624-3958 in-state; (406) 442-1837 out of state


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