Wiki Appropriate Hospital billing on angiographies - What is the appropriate billable unit

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bsitterle

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What is the appropriate billable units for CPT 75705 ( and other comparable codes) when being billed by a hospital for the technical services? Any help would be appreciated!!
 
Hello, the billed units should match the units documented in the medical record. CPT 75705 is billed for each vessel studied. The professional component billed on the physician's claim and the technical component billed on the facility claim should have matching units as supported by the records.

I hope this info is helpful.

Jean Kayser CPC CIRCC
 
Thanks for the information, Jean! Can you point me in the direction of documentation that supports this?? Thank you so much for your assistance!
 
Hello, here is a link to CMS information regarding NCCI and MUE edits. On page 2, you will see that these edits are applied to physicians, hospitals and DME providers. Billing systems, including facility chargemasters, must have the correct units entered so pricing calculations are accurate. The correct reporting of units is essential for both professional and facility charges.

http://www.cms.gov/Outreach-and-Edu...NProducts/downloads/How-to-Use-NCCI-Tools.pdf

Regarding CPT 75705, here is a link to a question/answer provided by Karen Zupko & Associates. It gives clarification stating that CPT 75705 is billed by vessel.

http://www.karenzupko.com/resources/codingcoach/cc_neuroarchive_2011.html

Commercial payers may also have their own reimbursement policies to limit the number of units billed for specific CPT codes. Here is a link with a United Healthcare policy for "Maximum Frequency per Day." It shows a limit of 30 units for CPT 75705.

http://www.uhccommunityplan.com/con...-Maximum Frequency Per Day Policy (R0060).pdf

I hope this helps.

Jean Kayser CPC CIRCC
 
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