I have a situation that has not come up before and I?m unsure how to code it for the ASC.
A Medicare patient was to have a trial SCS placement with two 8 contact leads. Of the two leads to be implanted, the lead manufacturer rep. inadvertently opened a more expensive 16 contact lead for the first lead and the correct 8 contact lead for the second. The patient was already prepped, sedated and on the surgery table when this transpired. Both leads would work, however, due to the cost of the 16 contact lead incorrectly opened, the manufacturer agreed to not charge the ASC for that lead. The other lead was charged to the ASC.
Since Medicare now bundles the cost of the lead into the payment for the procedure, we would usually bill both leads. In this case, if we bill both leads we will be paid for both although one of the leads was essentially free. I have researched this issue and there is a FB modifier for ?payment when device is furnished with no cost? but I?m unsure if this only applies to hospital outpatient or does it apply to the ASC also? For example: 63650, 63650 FB? Is there another modifier we should use? I want to make sure we are billing this correctly.
Thank you for your help.
A Medicare patient was to have a trial SCS placement with two 8 contact leads. Of the two leads to be implanted, the lead manufacturer rep. inadvertently opened a more expensive 16 contact lead for the first lead and the correct 8 contact lead for the second. The patient was already prepped, sedated and on the surgery table when this transpired. Both leads would work, however, due to the cost of the 16 contact lead incorrectly opened, the manufacturer agreed to not charge the ASC for that lead. The other lead was charged to the ASC.
Since Medicare now bundles the cost of the lead into the payment for the procedure, we would usually bill both leads. In this case, if we bill both leads we will be paid for both although one of the leads was essentially free. I have researched this issue and there is a FB modifier for ?payment when device is furnished with no cost? but I?m unsure if this only applies to hospital outpatient or does it apply to the ASC also? For example: 63650, 63650 FB? Is there another modifier we should use? I want to make sure we are billing this correctly.
Thank you for your help.