Wiki Hospital outpatient coding for Iatrogenic bladder laceration repair

Hramsey

Guest
Messages
2
Location
Pleasant Shade, TN
Best answers
0
Chapter 1 of the NCCI Manual answers this question: "In this Manual, many policies are described using the term “physician.” Unless otherwise indicated, the use of this term does not restrict the application of policies to physicians only. Rather, the policies apply to all practitioners, hospitals, providers, or suppliers eligible to bill the relevant HCPCS/CPT codes pursuant to applicable portions of the Social Security Act (SSA) of 1965, the Code of Federal Regulations (CFR), and Medicare rules. In some sections of this Manual, the term “physician” would not include some of these entities because specific rules do not apply to them. For example, Anesthesia Rules [e.g., CMS “Internet-only Manual (IOM),” Publication 100-04 (“Medicare Claims Processing Manual”), Chapter 12 (Physician/Nonphysician Practitioners), Section 50 (Payment for Anesthesiology Services)] and Global Surgery Rules [e.g., CMS “Internet-only Manual (IOM),” Publication 100-04 (“Medicare Claims Processing Manual”), Chapter 12 (Physician/Nonphysician Practitioners), Section 40 (Surgeons and Global Surgery)] do not apply to hospitals."
In the case you describe, the code would not be reported on the hospital claim as this does not meet the category of not applying to hospitals.
 
Chapter 1 of the NCCI Manual answers this question: "In this Manual, many policies are described using the term “physician.” Unless otherwise indicated, the use of this term does not restrict the application of policies to physicians only. Rather, the policies apply to all practitioners, hospitals, providers, or suppliers eligible to bill the relevant HCPCS/CPT codes pursuant to applicable portions of the Social Security Act (SSA) of 1965, the Code of Federal Regulations (CFR), and Medicare rules. In some sections of this Manual, the term “physician” would not include some of these entities because specific rules do not apply to them. For example, Anesthesia Rules [e.g., CMS “Internet-only Manual (IOM),” Publication 100-04 (“Medicare Claims Processing Manual”), Chapter 12 (Physician/Nonphysician Practitioners), Section 50 (Payment for Anesthesiology Services)] and Global Surgery Rules [e.g., CMS “Internet-only Manual (IOM),” Publication 100-04 (“Medicare Claims Processing Manual”), Chapter 12 (Physician/Nonphysician Practitioners), Section 40 (Surgeons and Global Surgery)] do not apply to hospitals."
In the case you describe, the code would not be reported on the hospital claim as this does not meet the category of not applying to hospitals.
Thank you!!
 
Top