Orthopedic Coding Alert

The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare beneficiaries who are in a Part A covered SNF stay or in a Part B non-covered SNF stay in which their Part A benefits are exhausted. For these patients, orthopedists who bill the global x-ray service directly to Medicare for these patients will receive denials. CMS Program Memorandum B-00-67 states, "Medicare carriers will no longer make payment to physicians and suppliers for technical components of physician services furnished to beneficiaries in the course of a Medicare Part A covered stay."

Medicare's rationale for the x-ray denials is that they believe the x-rays should actually be performed in the SNF, so they-re not going to pay you for the service. On some occasions, however, the SNF doesn't have the means to provide the x-rays. Or the patient presents to the orthopedic practice without knowing she-ll need an x-ray.

Keep in mind that consolidated billing for x-ray services does not apply to Medicare beneficiaries in a non-covered Part A SNF stay. For those patients, you can bill the carrier directly for the global x-ray fee. Visit http://www.cms.hhs.gov/SNFConsolidatedBilling/01_overview.asp for more details on consolidated billing