Part B Insider (Multispecialty) Coding Alert
Send Letter, Documentation
When you're billing with the -22 modifier or a Not Otherwise Classified (NOC) code, you need to explain to the carrier what happened and the reason why you're seeking extra reimbursement.
WPS Medicare Administrators says it can't automate the processing of claims with NOC codes or the -22 modifier, because there are no consistent or standardized payment criteria which it can apply. Thus, the carrier suspends these claims for manual review by a human. This person will want to see an operative note or a procedure report.
"The minimum you have to send is an op note," says Laura Talbert with Shore Billing & Management in Allen, MD. "It's recommended that you send a letter" explaining the billing as well. And if the physician uses a NOC code instead of the -22 modifier, the letter should go into the reasons for that decision as well. But in many cases, you should be prepared to receive a partial denial and appeal it.
"The letter, in the case of a claim containing an NOC code, should indicate exactly why an existing code is not being used and which definitive, existing CPT Codes would most closely describe the NOC service," says WPS. "Any additional, precise information you can supply will help us adjudicate these claims in a fair and timely fashion," the carrier adds.
Be prepared to "work to get those claims paid," advises Talbert.
Part B Insider (Multispecialty) Coding Alert
- Reimbursement:
Don't NOC It Until You Try
If the physician did extra work, consider modifier before unlisted code
Doctors [...] - Modifiers:
Use -58, Not -78 When Open Reduction Follows Closed
Document that the physician discussed risks the first time
When you're providing global fracture care, the [...] - Use -76, -77 Modifiers for Repeat Closed Reductions
If the same physician has to go back and perform a closed reduction a second [...] - Unlisted Procedures:
NOC Versus -22 Modifier: Controversy And Judgment Calls
We'll show you the "most correct" code for every situation
If you're [...] - NOC Or -22:
Send Letter, Documentation
When you're billing with the -22 modifier or a Not Otherwise Classified (NOC) code, you [...] - Anatomy :
Look For Bovine Arch, Other Anomalies In Cardiac Patients
Scan operative report for clues to bovine arch
The bovine arch is fairly common, occurring in [...] - CMS Clarifies Chemotherapy, E/M Billing
Billing for chemotherapy and drug infusions just became a bit simpler.
In Transmittal 147, issued April [...] - Add-On Codes:
4 Pointers Make 'Add-On' Codes Easy
Don't accept payment reductions, or you could lose up to 50% on every claim
[...] - Part B Coding Coach:
4 Tips Improve Your 51701
Combat E/M and catheterization denials with documentation, diagnoses and modifier
When billing for office visits that [...] - Physician Notes:
It's Good To Be Unusual -- But Not In Your Billing Practices
Abnormal patterns trigger scrutiny by OIG, other watchdogs
If your claim submissions [...]
