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Pulmonology Coding Alert

CMS Consolidates Information

Published on Fri Mar 01, 2002

CMS recently compiled information about consolidated billing on its Web site at www.hcfa.gov/medlearn/refsnf.htm. In addition to a new question and answer section, CMS has posted four code files accessible from this Web address, which include codes for:

 
  • Physician professional services (other than the interpretation of diagnostic tests) that are not included in consolidated billing and must be billed to the carrier or durable medical equipment regional carrier for payment. This includes the CPT codes for various types of bronchoscopies, for example.
     
  • Physician interpretation of diagnostic tests that are always paid by the Part B carriers when submitted with modifier -26 (Professional component).

     
  • Ambulance services that are always denied by Part B carriers for Part A-stay SNF residents when submitted with an -NN modifier (connotes an ambulance trip originating and  returning to the SNF).

     
  • Physical, occupational and speech therapy services, which must always be submitted to the SNF for payment when provided in the physician office, outpatient hospital or other setting.

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