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codedog

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Our ASC is billing CPT codes 63685, 63650-63650-59. Its a medicare patient
My supervisor wants us to bill the device codes -L8680 AND L8687. I told her that we cannot bill the L -CODES with medicare. Only the procedure codes .
She insist that we will take a loss if we just bill the procedure code. Who is right and wrong in this situation . And if I am right , which I am pretty sure, can someone explain it better , maybe my supervisor may see if different . PLEASE respond , thanks
 
(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

Go to the CMS website and search for the ASC device intensive procedures for 2010. The codes mentioned above are Medicare device intensive codes and the Medicare reimbursement automatically includes reimbursement for the implants. So, you are correct. If you have filed a similar claim previously for Medicare, pull it and show your supervisor how much was reimbursed. If you have not filed a similar claim previously, then go ahead and file with the implants, and show your supervisor the denial when it arrives.

Richard Mann, your pain management coder
rkmcoder@yahoo.com
 
Richard,
Do I put the whole amount that was on the invoice to medicare. , EVEN thoughv it is more than medicare will reimburse ?
 
(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

Yes, the entire amount, includung shipping and taxes.

Richard Mann, your pain management coder
rkmcoder@yahoo.com
 
OK, SO if I am billing 63685, 63650, 63650-59
. how would you bill it

63685-procedure charge plus invoice ?

63650-just procedure charge ?
63650-just procedure charge ?
in other words where do I Place my invoice charges
if you dont mind, give me an example , thanks
 
(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

63685
63650
63650-59
C1778-GY (invoice cost of leads)
C1820-GY (invoice cost of IPG)

These last two are the HCPCS level II codes for the leads and the IPG. The -GY is added because it is an unreimbursed (N1) code for Medicare. Leave the -GY off to see the denial. With the -GY there, the codes will be ignored. All that said, if you are coding/billing for an ASC, you must learn this stuff, as it is basic to Medicare billing in an ASC. Without this knowledge, you will often be floundering not knowing what to do. A resource to gain this knowledge is at:

http://www.ellismedical.com/

This is the resource we use for all ASC coding/billing knowledge.

Richard Mann, your pain management coder
rkmcoder@yahoo.com
 
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