Ob-Gyn Coding Alert

Question: Are there special rules for coding ob-gyn services for Hurricane Katrina evacuees?


Georgia Subscriber

Answer: Medicare released a new modifier (CR, Catastrophe/disaster related) to use when reporting services provided to victims of Hurricane Katrina located in any part of the country. The new modifier is effective for dates of service on and after Aug. 21, 2005.

You should use this modifier when the physician sees a patient and either has no access to records or cannot get confirmation from CMS of the patient's eligibility because she has become displaced due to a disaster. In other words, if your physician has good information, you will not need modifier CR.
 
In light of the devastation caused by the hurricane, which left physicians with little access to medical records and proof of Medicare enrollment, Medicare is waiving the normal requirements for documentation (but not documentation that relates to billing the appropriate code) and allowing for presumption of eligibility.

Fraud and abuse will still be subject to sanctions, but services provided in good faith will be reimbursed.

Modifier CR is for physicians and suppliers billing a local carrier or DMERC. Condition code DR (Disaster related) is available for fiscal intermediary billing.

For more information, see CR4106 available at www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.