ED Coding and Reimbursement Alert

Wondering why your claims are denying due to incorrect patient info? Get the answers straight from Part B reps.

Do you face issues when submitting claims with modifier 50 (Bilateral procedure) appended? Are you tired of seeing rejections because payers say you don’t have the right Medicare information for your patients? You can rectify these issues with a few simple tips.

That was the word from CGS Medicare’s Towanna Tripp during the payer’s January 21, 2021 “Frequently Asked Question” webinar. She revealed the answers to six pressing community questions during the session, and we’ve got the updates most applicable to ED coders.

Question 1: What Is the Update for Code 99072?

Most EDs are aware that a new code debuted for additional supplies, material, and clinical staff time during the public health emergency (PHE). However, many providers are unsure of how to report 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other nonfacility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease).

“CMS has not changed its position on this code,” Tripp said. “It’s treated like any other supply code — there are no RVUs for it, and therefore there’s no fee schedule amount established for it. Also, this is considered a bundled procedure code, so if you bill an office visit and 99072, we’re going to deny it as bundled. The patient is not responsible for your office supplies.”

She also indicated that CGS doesn’t expect CMS to make further changes to the guidance for this service. “As far as we know, this is going to be CMS’ final say-so about this code,” she said. “It is not separately payable to anyone — physicians or hospitals.”

Question 2: Who Can Bill for the COVID Vaccines?

Although not every ED has the option of receiving COVID vaccine supplies, some do, which may make you wonder whether you need to meet any specific eligibility requirements to bill these.

“If you’re already a Medicare provider and you can already give the flu and pneumonia vaccines, you can give this vaccine,” Tripp said. “You don’t need to take any additional action to administer and bill the COVID vaccine,” she noted.

If you’re a provider who doesn’t already give vaccines but you want to (for instance, a radiation therapy center), contact your Part B MAC and ask to be separately enrolled as a mass immunizer, she said.

Question 3: How Much Money Do We Bill Medicare for the COVID Vaccine?

Although you may be tempted to create an internal fee schedule amount for the COVID vaccine, the reality is that the medication itself gets a zero charge to Medicare payers, Tripp said.

“Right now, since the government is giving away the COVID-19 vaccine for free, you will only bill for the administration code,” Tripp said. “The vaccine right now is not needed on the claim, our system is set up to accept the administration only, but if you have to bill for the vaccine, (for instance, if your state law requires you to do that), you can bill it with a charge of one cent,” she said.

Like the influenza and pneumonia vaccines, there are no deductibles, coinsurance, or copayments for the COVID vaccines.

Question 4: Are the COVID Vaccine Rules Different for Medicare Advantage (MA)?

CMS advises Medicare Advantage providers to submit vaccine claims to the MAC, so many coders want to know if they should submit those claims to Medicare instead of the managed care payer.

“Yes,” Tripp said. “If you have a patient who’s enrolled in a Medicare managed care plan, much like hospice services or clinical trials, if you give the COVID vaccine to the patient, you’ll bill those administration claims to us and we will pay that for the MA patient.”

No particular modifiers are necessary — you can just bill the code as-is,” she said. “This is for COVID only, this does not include the flu or pneumonia vaccines.”

Question 5: Why Are Our Claims Denying for Invalid Patient Information?

If you’ve ever gotten a claim denied for invalid patient information and you’re sure you submitted the correct Medicare Beneficiary Identifier (MBI) to the payer, you’re not alone, Tripp said.

“We get this question a lot, especially with the new MBI,” she noted. If this happens, you should first verify the patient’s name spelling and that the patient’s name and MBI match, she said.

One way this can happen is if a patient loses their Medicare card. In the past, they’d get a new card with the same ID number on it as they had before (which was their Social Security number). However, with the MBI, if a patient loses their card, Medicare will send them a new card with a totally new MBI on it, she added.