Reader Questions: Report Cochlear Implants With Revenue Code 278

Check With Payer for L Code

Question: Our facility is not a licensed DME carrier. Can we report the L8614 and L8619 codes for cochlear implants when the physician implants them in the operating room?
 
Vermont Subscriber

Answer: You can report codes L8614 (Cochlear device/ system) and L8619 (Cochlear implant external speech processor, replacement) using revenue code 278, even if your facility isn't a licensed carrier of durable medical equipment (DME). Keep in mind, though, that you may not receive separate reimbursement for the implant.

If you're billing Medicare or a government payer, the implant charge will be packaged under the ambulatory payment classification (APC) payment for the procedure. To receive reimbursement from Medicare, you would have to be a licensed DME carrier and submit the L code to your local DME carrier. Private payers may separately reimburse you, as a fee-for-service or percent-of-charge, so you should check the individual payer.




Use 451 With EMTALA Screenings

Question: When we treat a patient in the emergency department, should we bill for triage with revenue code 451 and bill for additional services with revenue code 452 or 456 (depending on what the service is)? This would require two facility evaluation and management codes. We have always included triage and other services in one charge, billed under revenue code 450.
  
California Subscriber

Answer: Revenue code 451 is for reporting Emergency Medical Treatment and Active Labor Act (EMTALA) emergency medical screening services only. You may report it as a stand-alone code in certain circumstances - for example, when a patient receives an EMTALA screening exam by a physician (or other qualified medical professional) as deemed appropriate by state and facility bylaws, and then leaves against the medical advice of the supervising physician.

If hospital staff screen the patient and determine her non-emergent, and the patient then receives further services in an urgent care setting, you may report revenue codes 452 or 456 in conjunction with 451. In most cases, though, when a patient presents to the emergency department, the staff performs triage care, gives the patient an appropriate EMTALA screening exam, and the physicians then determine that the patient requires further emergent care. You should report the triage, screening, and further patient evaluation under a single evaluation and management code under revenue code 450.

For these services, you'll choose one of the following codes:
  99281 - Emergency department visit for the evaluation and   management of a patient, which   requires these three key components: a problem-focused history,  a problem-focused examination,  and straightforward medical decision-making
  99282 - ...an expanded problem-focused history, an expanded  problem-focused examination, and medical decision-making of   low complexity
  99283 - ...an expanded problem-focused history, an expanded  problem-focused examination,  and medical decision-making of   moderate complexity
  99284 - ...a detailed history,   a detailed examination, and medical decision-making of moderate  complexity
  99285 - ...a comprehensive  history, a comprehensive examination, and medical decision-making of high complexity.

- Reader Questions reviewed by Sarah L. Goodman, MBA, CPC, CPC-H, president of SLG Inc. in Raleigh, N.C.