Melissa*Ever*Evolving
Networker
Yes, Unfortunately, I am bringing this topic up again.
I have been receiving denials for modifier combinations with:
00812-AA-PT
00813-AA-PT-QS
After much deliberation, we had changed claim 00812-AA-PT to 00811-AA-PT. (This began as screen and turned diagnostic)
Based on many references stating Medicare would not follow the AMA instruction of "once a screen, always a screen."
On the 00813-AA-PT-QS, my team and I decided that it is possible that CMS will not consider the colonoscopy preventive benefit since there were symptoms presented to also perform the EGD. (However, The colonoscopy portion was a screening.) We dropped off the PT in this mindset.
Now today, I have discovered an update to the NCD 210.3 posted by MLN Matters article MM10473 Released 2/16/18.
Please see the attachment for the information being released to our MACs to adjust their Processing!
I am so confused.
Why can't CMS publish something to cover all cicumstances regarding colonoscopies and the new Anesthesia codes and stick to it?![Mad :mad: :mad:](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.
Thank you so much in advance!
~Melissa, CPC
I have been receiving denials for modifier combinations with:
00812-AA-PT
00813-AA-PT-QS
After much deliberation, we had changed claim 00812-AA-PT to 00811-AA-PT. (This began as screen and turned diagnostic)
Based on many references stating Medicare would not follow the AMA instruction of "once a screen, always a screen."
On the 00813-AA-PT-QS, my team and I decided that it is possible that CMS will not consider the colonoscopy preventive benefit since there were symptoms presented to also perform the EGD. (However, The colonoscopy portion was a screening.) We dropped off the PT in this mindset.
Now today, I have discovered an update to the NCD 210.3 posted by MLN Matters article MM10473 Released 2/16/18.
Please see the attachment for the information being released to our MACs to adjust their Processing!
I am so confused.
Why can't CMS publish something to cover all cicumstances regarding colonoscopies and the new Anesthesia codes and stick to it?
Does anyone have an awesome tool to help with this for MEDICARE claims? I understand commercial carriers vary.
Thank you so much in advance!
~Melissa, CPC