Thursday, October 5, 2017

Facility hospice claim billing - revenue code 0651, 0658 - 0659

BILLING INSTRUCTIONS FOR HOSPICE CLAIM COMPLETION

Use UB 04 form

* Admission Date: Include the admission date for hospice care.

* Inpatient Respite Care: "Occurrence Span Code" - include occurrence span code M2 and complete the "from and through" dates for an episode of inpatient respite care.

* Core Based Statistical Area (CBSA): "Value Codes" - include value code 61 in the value code field and report the CBSA number. Hospice claims must be reported with a valid CBSA code based on the location of the beneficiary receiving services.

* Use the Revenue Codes listed below:

Revenue Code Description

0651 Routine Home Care I

0652 Continuous Home Care

0655 Inpatient Respite Care

0656 General Inpatient Care

0657 Physician Services

0658 Other Hospice I (Room & Board)

0659 Other Hospice Service – Facility Innovative Design


Supplemental (FIDS) Bed

* To bill for room and board in a nursing facility, licensed hospice long-term care unit, or Ventilator Dependent Care Unit (VDCU), use Revenue Code 0658. Providers must bill their customary room and board rate and Medicaid pays the usual and customary rate or the Medicaid fee screen, whichever is less. Room and board is reimbursable on the day of discharge if the discharge is due to resident death or the resident is discharged from hospice but remains in the NF. NOTE:

To ensure proper payment for a beneficiary in a VDCU, the VDCU provider identification number must be on the Hospice Membership Notice (DCH-1074). When a beneficiary resides in a VDCU/Dialysis Unit under which the VDCU has a special agreement with Medicaid and elects hospice, a prior authorization (PA) number for hospice is not required.

* To bill for room and board in a nursing facility when the beneficiary resides in a Facility Innovative Design Supplemental (FIDS) bed, use Revenue Code 0659.

* Revenue Code 0657 Physician Services requires inclusion of a HCPCS code on the claim line. Each Physician service must be billed on a separate claim line.

* Revenue Code 0652 Continuous Home Care must be billed for each date of service on separate claim lines. To receive the Continuous Home Care rate under code 0652, a minimum of 8 hours1 of care, not necessarily consecutive, in a 24-hour period is required. Less than 8 hours is reported under code 0651. A portion of an hour counts as an hour for this determination.

* Hospital Leave Days must be billed using Revenue Code 0185 (must not exceed 10 consecutive days). Reimbursement is at 100 percent of class-wide Nursing Facility Hospital Leave Day rate for qualifying facilities.

* Therapeutic Leave Days must be billed using Revenue Code 0183 (must not exceed 18 total days for the year) or Revenue Code 0189, Therapeutic Leave Days, for a beneficiary in a Facility Innovative Design Supplemental (FIDS) bed. Reimbursement is at 95 percent of Nursing Facility rate for leave days.

* Hospice services are reimbursable for day of discharge if services were rendered, regardless of the setting in which the services were provided. (See first bullet for instructions regarding room and board.)

* When billing for a hospice/NF resident who has been approved for complex care, bill revenue code 0120 and include the assigned PA number in F.L. 84, as obtained from the NF.

The Michigan Medicaid program, including Medicaid Health Plans (MHPs) and MIChild, as well as CSHCS, covers hospice care for children under 21 years of age concurrently with curative treatment of the child’s terminal illness when the child qualifies for hospice as described in the Hospice Chapter of this manual.


Hospice services and curative treatment are billed and reimbursed separately under this policy. Prior to billing, it is important that providers differentiate between services that are palliative and therefore included in hospice reimbursement, and those that are curative and separately reimbursable under Medicaid. Each child’s circumstances will need to be taken into consideration when making this distinction. Caution should be taken to avoid billing both the hospice and Medicaid for the same service as this represents double billing and may constitute fraud.

Tuesday, September 19, 2017

icd 10 code for dermatitis


Viral infections characterized by skin and mucous membrane lesions (B00-B09) 

B00 Herpesviral [herpes simplex] infections

Excludes1: congenital herpesviral infections (P35.2)

Excludes2: anogenital herpesviral infection (A60.-) gammaherpesviral mononucleosis (B27.0-) herpangina (B08.5)

B00.0 Eczema herpeticum Kaposi's varicelliform eruption

B00.1 Herpesviral vesicular dermatitis

Herpes simplex facialis
Herpes simplex labialis
Herpes simplex otitis externa
Vesicular dermatitis of ear
Vesicular dermatitis of lip

B00.2 Herpesviral gingivostomatitis and pharyngotonsillitis Herpesviral pharyngitis
B00.3 Herpesviral meningitis
B00.4 Herpesviral encephalitis Herpesviral meningoencephalitis Simian B disease Excludes1: herpesviral encephalitis due to herpesvirus 6 and 7 (B10.01,
B10.09) non-simplex herpesviral encephalitis (B10.0-)
B00.5 Herpesviral ocular disease
B00.50 Herpesviral ocular disease, unspecified
B00.51 Herpesviral iridocyclitis Herpesviral iritis  Herpesviral uveitis, anterior
B00.52 Herpesviral keratitis Herpesviral keratoconjunctivitis
B00.53 Herpesviral conjunctivitis
B00.59 Other herpesviral disease of eye Herpesviral dermatitis of eyelid
B00.7 Disseminated herpesviral disease Herpesviral sepsis
B00.8 Other forms of herpesviral infections
B00.81 Herpesviral hepatitis
B00.82 Herpes simplex myelitis
B00.89 Other herpesviral infection Herpesviral whitlow
B00.9 Herpesviral infection, unspecified Herpes simplex infection NOS
B08 Other viral infections characterized by skin and mucous membrane lesions, not elsewhere classified

Excludes1: vesicular stomatitis virus disease (A93.8)

B08.0 Other orthopoxvirus infections

Excludes2: monkeypox (B04)

B08.01 Cowpox and vaccinia not from vaccine
B08.010 Cowpox
B08.011 Vaccinia not from vaccine Excludes1: vaccinia (from vaccination) (generalized) (T88.1)
B08.02 Orf virus disease Contagious pustular dermatitis Ecthyma contagiosum
B08.03 Pseudocowpox [milker's node]
B08.04 Paravaccinia, unspecified
B08.09 Other orthopoxvirus infections Orthopoxvirus infection NOS
B08.1 Molluscum contagiosum
B08.2 Exanthema subitum [sixth disease] Roseola infantum
B08.20 Exanthema subitum [sixth disease], unspecified Roseola infantum, unspecified
B08.21 Exanthema subitum [sixth disease] due to human herpesvirus 6 Roseola infantum due to human herpesvirus 6

B37 Candidiasis Includes: candidosis moniliasis

Excludes1: neonatal candidiasis (P37.5)
B37.0 Candidal stomatitis Oral thrush
B37.1 Pulmonary candidiasis Candidal bronchitis Candidal pneumonia
B37.2 Candidiasis of skin and nail Candidal onychia Candidal paronychia

Excludes2: diaper dermatitis (L22)

B37.3 Candidiasis of vulva and vagina Candidal vulvovaginitis Monilial vulvovaginitis Vaginal thrush
B37.4 Candidiasis of other urogenital sites
B37.41 Candidal cystitis and urethritis
B37.42 Candidal balanitis
B37.49 Other urogenital candidiasis Candidal pyelonephritis
B37.5 Candidal meningitis
B37.6 Candidal endocarditis
B37.7 Candidal sepsis Disseminated candidiasis Systemic candidiasis
B37.8 Candidiasis of other sites
B37.81 Candidal esophagitis
B37.82 Candidal enteritis Candidal proctitis
B37.83 Candidal cheilitis
B37.84 Candidal otitis externa
B37.89 Other sites of candidiasis Candidal osteomyelitis
B37.9 Candidiasis, unspecified Thrush NOS

Helminthiases (B65-B83)

B65 Schistosomiasis [bilharziasis]

Includes: snail fever

B65.0 Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis]
B65.1 Schistosomiasis due to Schistosoma mansoni [intestinal schistosomiasis]
B65.2 Schistosomiasis due to Schistosoma japonicum Asiatic schistosomiasis
B65.3 Cercarial dermatitis Swimmer's itch
B65.8 Other schistosomiasis
Infection due to Schistosoma intercalatum
Infection due to Schistosoma mattheei
Infection due to Schistosoma mekongi

B65.9 Schistosomiasis, unspecified

B88 Other infestations
B88.0 Other acariasis
Acarine dermatitis
Dermatitis due to Demodex species
Dermatitis due to Dermanyssus gallinae
Dermatitis due to Liponyssoides sanguineus
Trombiculosis

Excludes2: scabies (B86)

B88.1 Tungiasis [sandflea infestation]

B88.2 Other arthropod infestations Scarabiasis

B88.3 External hirudiniasis Leech infestation NOS

Excludes2: internal hirudiniasis (B83.4)
B88.8 Other specified infestations Ichthyoparasitism due to Vandellia cirrhosa Linguatulosis Porocephaliasis
B88.9 Infestation, unspecified Infestation (skin) NOS Infestation by mites NOS Skin parasites NOS

D89.8 Other specified disorders involving the immune mechanism, not elsewhere classified
D89.81 Graft-versus-host disease Code first underlying cause, such as: complications of transplanted organs and tissue (T86.-) complications of blood transfusion (T80.89)

Use additional code to identify associated manifestations, such as: desquamative dermatitis (L30.8) diarrhea (R19.7) elevated bilirubin (R17) hair loss (L65.9)

D89.810 Acute graft-versus-host disease
D89.811 Chronic graft-versus-host disease
D89.812 Acute on chronic graft-versus-host disease
D89.813 Graft-versus-host disease, unspecified
D89.82 Autoimmune lymphoproliferative syndrome [ALPS]
D89.89 Other specified disorders involving the immune mechanism, not elsewhere classified
Excludes1: human immunodeficiency virus disease (B20)
D89.9 Disorder involving the immune mechanism, unspecified

Immune disease NOS

E08.6 Diabetes mellitus due to underlying condition with other specified complications
E08.61 Diabetes mellitus due to underlying condition with diabetic arthropathy
E08.610 Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy Diabetes mellitus due to underlying condition with Charcot's joints
E08.618 Diabetes mellitus due to underlying condition with other diabetic arthropathy
E08.62 Diabetes mellitus due to underlying condition with skin complications
E08.620 Diabetes mellitus due to underlying condition with diabetic dermatitis Diabetes mellitus due to underlying condition with diabetic necrobiosis lipoidica
E08.621 Diabetes mellitus due to underlying condition with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-)
E08.622 Diabetes mellitus due to underlying condition with other skin ulcer Use additional code to identify site of ulcer (L97.1-
L97.9, L98.41-L98.49)
E08.628 Diabetes mellitus due to underlying condition with other skin complications
E08.63 Diabetes mellitus due to underlying condition with oral complications
E08.630 Diabetes mellitus due to underlying condition with periodontal disease
E08.638 Diabetes mellitus due to underlying condition with other oral complications
E08.64 Diabetes mellitus due to underlying condition with hypoglycemia
E08.641 Diabetes mellitus due to underlying condition with hypoglycemia with coma
E08.649 Diabetes mellitus due to underlying condition with hypoglycemia without coma

E08.65 Diabetes mellitus due to underlying condition with hyperglycemia
E08.69 Diabetes mellitus due to underlying condition with other specified complication Use additional code to identify complication
E08.8 Diabetes mellitus due to underlying condition with unspecified complications
E08.9 Diabetes mellitus due to underlying condition without complications

E10.6 Type 1 diabetes mellitus with other specified complications
E10.61 Type 1 diabetes mellitus with diabetic arthropathy
E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy

Type 1 diabetes mellitus with Charcot's joints

E10.618 Type 1 diabetes mellitus with other diabetic arthropathy
E10.62 Type 1 diabetes mellitus with skin complications
E10.620 Type 1 diabetes mellitus with diabetic dermatitis Type 1 diabetes mellitus with diabetic necrobiosis lipoidica
E10.621 Type 1 diabetes mellitus with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-)
E10.622 Type 1 diabetes mellitus with other skin ulcer Use additional code to identify site of ulcer (L97.1-
L97.9, L98.41-L98.49)
E10.628 Type 1 diabetes mellitus with other skin complications
E10.63 Type 1 diabetes mellitus with oral complications
E10.630 Type 1 diabetes mellitus with periodontal disease
E10.638 Type 1 diabetes mellitus with other oral complications
E10.64 Type 1 diabetes mellitus with hypoglycemia
E10.641 Type 1 diabetes mellitus with hypoglycemia with coma
E10.649 Type 1 diabetes mellitus with hypoglycemia without coma

E13.6 Other specified diabetes mellitus with other specified complications

E13.61 Other specified diabetes mellitus with diabetic arthropathy

E13.610 Other specified diabetes mellitus with
diabetic neuropathic arthropathy
Other specified diabetes mellitus with Charcot's joints

E13.618 Other specified diabetes mellitus with other diabetic arthropathy

E13.62 Other specified diabetes mellitus with skin complications

E13.620 Other specified diabetes mellitus with diabetic dermatitis Other specified diabetes mellitus with diabetic necrobiosis lipoidica
E13.621 Other specified diabetes mellitus with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-)
E13.622 Other specified diabetes mellitus with other skin ulcer Use additional code to identify site of ulcer (L97.1- L97.9, L98.41-L98.49)
E13.628 Other specified diabetes mellitus with other skin complications
E13.63 Other specified diabetes mellitus with oral complications
E13.630 Other specified diabetes mellitus with periodontal disease
E83.1 Disorders of iron metabolism
Excludes1: iron deficiency anemia (D50.-) sideroblastic anemia (D64.0-D64.3)
E83.10 Disorder of iron metabolism, unspecified
E83.11 Hemochromatosis
E83.19 Other disorders of iron metabolism
E83.2 Disorders of zinc metabolism Acrodermatitis enteropathica
E83.3 Disorders of phosphorus metabolism and phosphatases

Excludes1: adult osteomalacia (M83.-) osteoporosis (M80-)

E83.30 Disorder of phosphorus metabolism, unspecified

E83.31 Familial hypophosphatemia

Vitamin D-resistant osteomalacia
Vitamin D-resistant rickets

Excludes1: vitamin D-deficiency rickets (E55.0)

E83.32 Hereditary vitamin D-dependent rickets (type 1) (type 2) 25-hydroxyvitamin D 1-alpha-hydroxylase deficiency Pseudovitamin D deficiency Vitamin D receptor defect

E83.39 Other disorders of phosphorus metabolism
Acid phosphatase deficiency Hypophosphatasia

E83.4 Disorders of magnesium metabolism
E83.40 Disorders of magnesium metabolism, unspecified
E83.41 Hypermagnesemia
E83.42 Hypomagnesemia
E83.49 Other disorders of magnesium metabolism
E83.5 Disorders of calcium metabolism

Excludes1: chondrocalcinosis (M11.1-M11.2) hungry bone syndrome (E83.81) hyperparathyroidism (E21.0-E21.3)

E83.50 Unspecified disorder of calcium metabolism
E83.51 Hypocalcemia
E83.52 Hypercalcemia Familial hypocalciuric hypercalcemia
E83.59 Other disorders of calcium metabolism Idiopathic hypercalciuria
E83.8 Other disorders of mineral metabolism
E83.81 Hungry bone syndrome
E83.89 Other disorders of mineral metabolism
E83.9 Disorder of mineral metabolism, unspecified
F54 Psychological and behavioral factors associated with
disorders or diseases classified elsewhere
Psychological factors affecting physical conditions

Code first the associated physical disorder, such as:

asthma (J45.-)
dermatitis (L23-L25)
gastric ulcer (K25.-)
mucous colitis (K58.-)
ulcerative colitis (K51.-)
urticaria (L50.-)

Excludes2: tension-type headache (G44.2)

F68 Other disorders of adult personality and behavior

F68.1 Factitious disorder Compensation neurosis

Elaboration of physical symptoms for psychological reasons Hospital hopper syndrome M?nchhausen's syndrome Peregrinating patient

Excludes2: factitial dermatitis (L98.1) person feigning illness (with obvious motivation) (Z76.5)

F68.10 Factitious disorder, unspecified

F68.11 Factitious disorder with predominantly psychological signs and symptoms

F68.12 Factitious disorder with predominantly physical signs and symptoms

F68.13 Factitious disorder with combined psychological and physical signs and symptoms

F68.8 Other specified disorders of adult personality and behavior

H01.1 Noninfectious dermatoses of eyelid

H01.11 Allergic dermatitis of eyelid Contact dermatitis of eyelid

H01.111 Allergic dermatitis of right upper eyelid
H01.112 Allergic dermatitis of right lower eyelid
H01.113 Allergic dermatitis of right eye, unspecified eyelid
H01.114 Allergic dermatitis of left upper eyelid
H01.115 Allergic dermatitis of left lower eyelid
H01.116 Allergic dermatitis of left eye, unspecified eyelid
H01.119 Allergic dermatitis of unspecified eye, unspecified eyelid
H01.12 Discoid lupus erythematosus of eyelid
H01.121 Discoid lupus erythematosus of right upper eyelid
H01.122 Discoid lupus erythematosus of right lower eyelid
H01.123 Discoid lupus erythematosus of right eye, unspecified eyelid
H01.124 Discoid lupus erythematosus of left upper eyelid
H01.125 Discoid lupus erythematosus of left lower eyelid
H01.126 Discoid lupus erythematosus of left eye, unspecified eyelid
H01.129 Discoid lupus erythematosus of unspecified eye, unspecified eyelid
H01.13 Eczematous dermatitis of eyelid
H01.131 Eczematous dermatitis of right upper eyelid
H01.132 Eczematous dermatitis of right lower eyelid
H01.133 Eczematous dermatitis of right eye, unspecified eyelid
H01.134 Eczematous dermatitis of left upper eyelid
H01.135 Eczematous dermatitis of left lower eyelid
H01.136 Eczematous dermatitis of left eye, unspecified eyelid
H01.139 Eczematous dermatitis of unspecified eye, unspecified eyelid
H01.14 Xeroderma of eyelid
H01.141 Xeroderma of right upper eyelid
H01.142 Xeroderma of right lower eyelid
H01.143 Xeroderma of right eye, unspecified eyelid
H01.144 Xeroderma of left upper eyelid
H01.145 Xeroderma of left lower eyelid
H01.146 Xeroderma of left eye, unspecified eyelid
H01.149 Xeroderma of unspecified eye, unspecified eyelid
H01.8 Other specified inflammations of eyelid
H61 Other disorders of external ear
H61.0 Chondritis and perichondritis of external ear Chondrodermatitis nodularis chronica helicis

Perichondritis of auricle
Perichondritis of pinna

H61.00 Unspecified perichondritis of external ear
H61.001 Unspecified perichondritis of right external ear
H61.002 Unspecified perichondritis of left external ear
H61.003 Unspecified perichondritis of external ear, bilateral
H61.009 Unspecified perichondritis of external ear, unspecified ear
H61.01 Acute perichondritis of external ear
H61.011 Acute perichondritis of right external ear
H61.012 Acute perichondritis of left external ear
H61.013 Acute perichondritis of external ear, bilateral
H61.019 Acute perichondritis of external ear, unspecified ear
H61.02 Chronic perichondritis of external ear
I83.1 Varicose veins of lower extremities with inflammation Stasis dermatitis
I83.10 Varicose veins of unspecified lower extremity with inflammation
I83.11 Varicose veins of right lower extremity with inflammation
I83.12 Varicose veins of left lower extremity with inflammation
L10-L14 Bullous disorders
L20-L30 Dermatitis and eczema
L40-L45 Papulosquamous disorders
L49-L54 Urticaria and erythema
L55-L59 Radiation-related disorders of the skin and subcutaneous tissue
L60-L75 Disorders of skin appendages
L76 Intraoperative and postprocedural complications of skin and subcutaneous tissue

L80-L99 Other disorders of the skin and subcutaneous tissue

Infections of the skin and subcutaneous tissue (L00- L08)

Use additional code (B95-B97) to identify infectious agent.

Excludes2: hordeolum (H00.0)

infective dermatitis (L30.3)

local infections of skin classified in Chapter 1

lupus panniculitis (L93.2)

panniculitis NOS (M79.3)

panniculitis of neck and back (M54.0-)

perl?che NOS (K13.0)

perl?che due to candidiasis (B37.0)

perl?che due to riboflavin deficiency (E53.0)

pyogenic granuloma (L98.0)

relapsing panniculitis [Weber-Christian] (M35.6)

viral warts (B07.-)

zoster (B02.-) 

L08.0 Pyoderma Purulent dermatitis Septic dermatitis Suppurative dermatitis

Excludes1: pyoderma gangrenosum (L88) pyoderma vegetans (L08.81)

L12 Pemphigoid

Excludes1: herpes gestationis (O26.4-) impetigo herpetiformis (L40.1)

L12.0 Bullous pemphigoid

L12.1 Cicatricial pemphigoid Benign mucous membrane pemphigoid

L12.2 Chronic bullous disease of childhood Juvenile dermatitis herpetiformis

L12.3 Acquired epidermolysis bullosa

Excludes1: epidermolysis bullosa (congenital) (Q81.-)

L12.30 Acquired epidermolysis bullosa, unspecified

L12.31 Epidermolysis bullosa due to drug

Code first (T36-T50) to identify drug

L12.35 Other acquired epidermolysis bullosa

L12.8 Other pemphigoid

L12.9 Pemphigoid, unspecified

L13 Other bullous disorders

L13.0 Dermatitis herpetiformis Duhring's disease

Hydroa herpetiformis

Excludes1: juvenile dermatitis herpetiformis (L12.2) senile dermatitis herpetiformis (L12.0)

L13.1 Subcorneal pustular dermatitis Sneddon-Wilkinson disease

L13.8 Other specified bullous disorders

L13.9 Bullous disorder, unspecified  Dermatitis and eczema (L20-L30)

Note: In this block the terms dermatitis and eczema are used synonymously and interchangeably.

Excludes2: chronic (childhood) granulomatous disease (D71)

dermatitis gangrenosa (L88)

dermatitis herpetiformis (L13.0)

dry skin dermatitis (L85.3)

factitial dermatitis (L98.1)

perioral dermatitis (L71.0)

radiation-related disorders of the skin and subcutaneous tissue (L55-L59) stasis dermatitis (I83.1-I83.2)

L20 Atopic dermatitis

L20.0 Besnier's prurigo

L20.8 Other atopic dermatitis

Excludes2: circumscribed neurodermatitis (L28.0)

L20.81 Atopic neurodermatitis Diffuse neurodermatitis

L20.82 Flexural eczema

L20.83 Infantile (acute) (chronic) eczema

L20.84 Intrinsic (allergic) eczema

L20.89 Other atopic dermatitis

L20.9 Atopic dermatitis, unspecified

L21 Seborrheic dermatitis

Excludes2: infective dermatitis (L30.3)

seborrheic keratosis (L82.-)

L21.0 Seborrhea capitis Cradle cap

L21.1 Seborrheic infantile dermatitis

L21.8 Other seborrheic dermatitis

L21.9 Seborrheic dermatitis, unspecified

Seborrhea NOS

L22 Diaper dermatitis

Includes: Diaper erythema

Diaper rash

Psoriasiform diaper rash

L23 Allergic contact dermatitis

Code first (T36-T65), to identify drug or substance

Excludes1: allergy NOS (T78.40)

contact dermatitis NOS (L25.9)

dermatitis NOS (L30.9)

Excludes2: dermatitis due to substances taken internally (L27.-)

dermatitis of eyelid (H01.1-)

diaper dermatitis (L22)

eczema of external ear (H60.5-)

irritant contact dermatitis (L24.-)

perioral dermatitis (L71.0)

radiation-related disorders of the skin and subcutaneous tissue (L55- L59)

L23.0 Allergic contact dermatitis due to metals

Allergic contact dermatitis due to chromium

Allergic contact dermatitis due to nickel

L23.1 Allergic contact dermatitis due to adhesives

L23.2 Allergic contact dermatitis due to cosmetics

L23.3 Allergic contact dermatitis due to drugs in contact with skin

Excludes2: dermatitis due to ingested drugs and medicaments (L27.0- L27.1)

L23.4 Allergic contact dermatitis due to dyes

L23.5 Allergic contact dermatitis due to other chemical products

Allergic contact dermatitis due to cement

Allergic contact dermatitis due to insecticide

Allergic contact dermatitis due to plastic

Allergic contact dermatitis due to rubber

L23.6 Allergic contact dermatitis due to food in contact with the skin

Excludes2: dermatitis due to ingested food (L27.2)

L23.7 Allergic contact dermatitis due to plants, except food

Excludes2: allergy NOS due to pollen (J30.1)

L23.8 Allergic contact dermatitis due to other agents

L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander

Allergic contact dermatitis due to animal (cat) (dog) hair

L23.89 Allergic contact dermatitis due to other agents

L23.9 Allergic contact dermatitis, unspecified cause

Allergic contact eczema NOS

L24 Irritant contact dermatitis

Code first (T36-T65) to identify drug or substance

Excludes1: allergy NOS (T78.40)

contact dermatitis NOS (L25.9)

dermatitis NOS (L30.9)

Excludes2: allergic contact dermatitis (L23.-)

dermatitis due to substances taken internally (L27.-)

dermatitis of eyelid (H01.1-)

diaper dermatitis (L22)

eczema of external ear (H60.5-)

perioral dermatitis (L71.0)

radiation-related disorders of the skin and subcutaneous tissue (L55- L59)

L24.0 Irritant contact dermatitis due to detergents

L24.1 Irritant contact dermatitis due to oils and greases

L24.2 Irritant contact dermatitis due to solvents

Irritant contact dermatitis due to chlorocompound

Irritant contact dermatitis due to cyclohexane

Irritant contact dermatitis due to ester

Irritant contact dermatitis due to glycol

Irritant contact dermatitis due to hydrocarbon

Irritant contact dermatitis due to ketone

L24.3 Irritant contact dermatitis due to cosmetics

L24.4 Irritant contact dermatitis due to drugs in contact with skin

L24.5 Irritant contact dermatitis due to other chemical products

Irritant contact dermatitis due to cement

Irritant contact dermatitis due to insecticide

Irritant contact dermatitis due to plastic

Irritant contact dermatitis due to rubber

L24.6 Irritant contact dermatitis due to food in contact with skin

Excludes2: dermatitis due to ingested food (L27.2)

L24.7 Irritant contact dermatitis due to plants, except food

Excludes2: allergy NOS to pollen (J30.1)

L24.8 Irritant contact dermatitis due to other agents

L24.81 Irritant contact dermatitis due to metals

Irritant contact dermatitis due to chromium

Irritant contact dermatitis due to nickel

L24.89 Irritant contact dermatitis due to other agents Irritant contact dermatitis due to dyes

L24.9 Irritant contact dermatitis, unspecified cause Irritant contact eczema NOS

L25 Unspecified contact dermatitis

Code first (T36-T65), to identify drug or substance

Excludes1: allergic contact dermatitis (L23.-)

allergy NOS (T78.40)

dermatitis NOS (L30.9)

irritant contact dermatitis (L24.-)

Excludes2: dermatitis due to ingested substances (L27.-)

dermatitis of eyelid (H01.1-)

eczema of external ear (H60.5-)

perioral dermatitis (L71.0)

radiation-related disorders of the skin and subcutaneous tissue (L55- L59)

L25.0 Unspecified contact dermatitis due to cosmetics

L25.1 Unspecified contact dermatitis due to drugs in contact with skin

Excludes2: dermatitis due to ingested drugs and medicaments (L27.0- L27.1)

L25.2 Unspecified contact dermatitis due to dyes

L25.3 Unspecified contact dermatitis due to other chemical products

Unspecified contact dermatitis due to cement

Unspecified contact dermatitis due to insecticide

L25.4 Unspecified contact dermatitis due to food in contact with skin

Excludes2: dermatitis due to ingested food (L27.2)
L25.5 Unspecified contact dermatitis due to plants, except food

Excludes1: nettle rash (L50.9)

Excludes2: allergy NOS due to pollen (J30.1)

L25.8 Unspecified contact dermatitis due to other agents
L25.9 Unspecified contact dermatitis, unspecified cause
Contact dermatitis (occupational) NOS
Contact eczema (occupational) NOS

Tuesday, June 20, 2017

Home Health revenue codes 0420, 0430, 0424, 0421

Revenue Code Description

Home Health Care Visits

0642 Home iv therapy services-iv site care, central line

0643 Home iv therapy services- IV start/change, peripheral line

0644 Home iv therapy services-non-routine nursing, peripheral line

0645 Home iv therapy services-training patient/caregiver, central line

0646 Home iv therapy services-training, disabled patient, central line

0647 Home iv therapy services-training, patient/caregiver, peripheral line

0648 Home iv therapy services-training, disabled patient, peripheral line

0649 Home iv therapy services-other iv therapy services

Therapy by a Home Health Care Agency/Facility

Coding Clarification: These codes apply to the Home Health Care Visit limit with the following Bill Type:

• 032x : Home health - Home Health Services under a plan of treatment

* 034x : Home health - Home Health Services not under a plan of treatment

0420 Physical therapy-general

0421 Physical therapy-visit charge

0422 Physical therapy-hourly charge

0423 Physical therapy-group rate

0424 Physical therapy-evaluation or reevaluation

0429 Physical therapy-other physical therapy

0430 Occupational therapy-general

0431 Occupational therapy-visit charge

0432 Occupational therapy-hourly charge

0433 Occupational therapy-group rate

0434 Occupational therapy-evaluation or reevaluation

0439 Occupational therapy-other occupational therapy

0440 Speech therapy-language pathology-general

0441 Speech therapy-language pathology-visit charge

0442 Speech therapy-language pathology-hourly charge

0443 Speech therapy-language pathology-group rate

0444 Speech therapy-language pathology-evaluation or reevaluation

0449 Speech therapy-language pathology-other speech-language pathology


Hemophilia

For coverage of assisted administration of clotting factors and coagulant blood products, refer to the policy titled Assisted Administration of Clotting Factors and Coagulant Blood Products. For coverage of clotting factor and coagulant blood products, refer to the policy titled Clotting Factors and Coagulant Blood Products.

Essential Health Benefits for Individual and Small Group

For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”). Large group plans (both self-funded and fully insured), and small group ASO plans, are not subject to the requirement to offer coverage for EHBs. However, if such plans choose to provide coverage for benefits which are deemed EHBs, the ACA requires all dollar limits on those benefits to be removed on all Grandfathered and Non-Grandfathered plans. The determination of which benefits constitute EHBs is made on a state by state basis. As such, when using this policy, it is important to refer to the member specific benefit plan document to determine benefit coverage.



COVERAGE RATIONALE

Indications for Coverage

The services being requested must meet all of the following:

** Be ordered and directed by a treating practitioner or specialist (M.D., D.O., P.A. or N.P); and

** The care must be delivered or supervised by a licensed professional in order to obtain a specified medical outcome; and

** Services must be skilled care in nature (refer to the policy titled Skilled Care and Custodial Care Services and the Definitions section below); and

** Services must be intermittent and part time (typically provided for less than 4 hours per day; refer to the member specific benefit plan document for intermittent definitions, if provided); and

** Services are provided in the home in lieu of skilled care in another setting (such as but not limited to a nursing facility, acute inpatient rehabilitation or a hospital); and

** Services must be clinically appropriate and not more costly than an alternative health services; and

** A written treatment plan must be submitted with the request for specific services and supplies’ periodic review of the written treatment plan may be required for continued Skilled Care needs and progress toward goals; and

** Services are not provided for the comfort and convenience of the member or the member’s family; and

** Services are not custodial care in nature. Medical Necessity Plans

Use the criteria above where applicable.

Additional Information

** Medical supplies and medications that are used in conjunction with a home health care visit are covered as part of
that visit. Some examples are, but not limited to, surgical dressing, catheters, syringes, irrigation devices.

Reimbursement for home health care visits and supplies are contractually determined. ** Eligible physical, occupational and speech therapy received in the home from a Home Health Agency is covered under the Home Health Care section of the member’s certificate of coverage and/or summary of benefits. The Home Health Care section only applies to services that are rendered by a Home Health Agency.




Friday, May 19, 2017

CPT code 36005, 36010, 36011, 33282, 33284

36005 Injection procedure for extremity venography 0.95 $328 $50

36010 Introduction of catheter, superior or inferior vena cava 2.18 $492 $114

36011 Selective catheter placement, venous system; first order branch 3.14 $842 $164

36012 Second order, or more selective, branch 3.51 $868 $181


Insertion 33282 Implantation of patient-activated cardiac event recorder Removal 33284 Removal of an implantable, patient-activated cardiac event recorder

CPT code 36005 (injection procedure for extremity venography (including introduction of needle or intracatheter)) should not be utilized to report venous catheterization unless it is for the purpose of an injection procedure for extremity venography. Some physicians have misused this code to report any type of venous catheterization.

Reimbursement and Billing Instructions

The procedure code for the implantation of the patient-activated event recorder – ILR is CPT code 33282.The code for the removal of this device is 33284. These procedure codes have a 90-day global postoperative care designation for which care related to the surgical procedure is not separately reimbursable unless such care is nonroutine, such as treatment of complications. Note that removal of a patient-activated event recorder – ILR on the same day as the insertion of a cardiac pacemaker is considered part of the pacemaker insertion procedure and is not reimbursed separately.

Table 9 illustrates billing instructions for each place of service:

* If the procedure is performed when the patient is an inpatient for a related problem, submit an institutional claim (UB-04 claim form or electronic equivalent) using a medically necessary diagnosis code.

* If the procedure is performed on an outpatient basis, submit an institutional claim (UB-04 claim form or electronic equivalent) using revenue code 360 and CPT code 33282 for implantation. The facility should bill for the device itself on a professional claim (CMS-1500 claim form or electronic equivalent) using HCPCS code E0616 with medically necessary primary diagnosis codes. Use CPT code 33284 with revenue code 360 to bill for removal of the device. Physician’s charges for the surgery should be billed by the physician on a professional claim.

* If the procedure is performed in a physician’s office, the physician should bill CPT code 33282 for implantation and E0616 for the device. Both codes are billed on a professional claim (CMS-1500 claim form or electronic equivalent). 

Type of Claim Institutional Institutional (and professional, if billing for device) Professional Revenue and

CPT Codes Revenue code 360

CPT code not needed Revenue code 360

CPT code 33282 for insertion

CPT code 33284 for removal Revenue code not applicable

CPT code 33282 for insertion

CPT code 33284 for removal

HCPCS Code Not needed On professional claim – E0616 On institutional claim – Not needed E0616

Note: Institutional claim formats include the UB-04 paper claim form, the 837I electronic transaction, and the institutional claim type on the Provider Healthcare Portal. Professional claim formats include the CMS-1500 paper claim form, the 837P electronic transaction, and the professional claim type on the Provider Healthcare Portal



Billing/Coding/Physician Documentation Information

This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category Search on the Medical Policy search page.

Applicable codes: 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272, 33282, 33284, E0616,0295T, 0296T, 0297T, 0298T

BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.

Wednesday, May 17, 2017

Time span code billing guidelines - 93268 , 93272, 94005

REIMBURSEMENT GUIDELINES

Time Span Codes

Oxford will reimburse a CPT or HCPCS Level II code that specifies a time period for which it should be reported (e.g., weekly, monthly), once during that time period. The time period is based on sourcing from the AMA or CMS including: the CPT or HCPCS code description, CPT book parentheticals and other coding guidance in the CPT book, other AMA publications or CMS publications.

For example: Within the CPT book, the code description for CPT code 95250 states, “Ambulatory continuous glucose monitoring of interstitial tissue fluid via subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording”. In addition to that code description, there is also a parenthetical that provides further instructions with regard to the frequency the code can be reported. The parenthetical states, “Do not report 95250 more than once per month”. Oxford will reimburse CPT Code 95250 only once per month for the same member, for services provided by the Same Group Physician and/or Other Health Care Professional. In order to consider reimbursement for these services that may be repeated following a month with fewer than 31 days, Oxford may allow reimbursement of monthly time span codes when these codes are reported with dates of service at least 28 days apart.

CPT coding guidelines specify for physicians or other qualified health care professionals to select the name of the procedure or service that accurately identifies the services performed.



End-Stage Renal Disease Services (ESRD) 90951-90962 

CPT codes 90951-90962 are grouped by age of the patient and the number of face-to-face physician or other qualified health care professional visits provided per month (i.e., 1, 2-3, or 4 or more). Oxford will reimburse the single most comprehensive outpatient ESRD code submitted per age category (i.e., under 2 years of age, 2-11 years of age, 11- 19 years of age, and 20 years of age and older) once per month. This aligns with CPT coding guidance which states to report the age-specific ESRD codes should be reported once per month for all physician or other health care professional face-to-face outpatient services.




Time Span Comprehensive and Component Codes

When related Time Span Codes which share a common portion of a code description are both reported during the same time span period by the Same Group Physicians and/or Other Health Care Professional for the same patient, the code with the most comprehensive description is the reimbursable service. The other code is considered inclusive and is not a separately reimbursable service. No modifiers will override this denial. The following example illustrates how the CPT book lists code 93268 first as it is the comprehensive code. CPT codes 93270, 93271, and 93272 are indented and each share a common component of their code description with CPT code 93268.


When CPT code 93270, 93271, or 93272 are reported with CPT 93268 during the same 30 day period by the Same Group Physician and/or Other Health Care Professional for the same patient, only CPT code 93268 is the reimbursable service.

The Time Span Comprehensive and Component Codes list includes applicable comprehensive and related component Time Span Codes.

DEFINITIONS Calendar Month: Oxford defines Calendar Month as the time span referring to an individually named month of the year, (e.g., January, February) and includes codes with Calendar Month in their description.



Same Group Physician and/or Other Health Care Professional: All physicians and/or other health care professionals of the same group reporting the same Federal Tax Identification number.

Time Span Code: A CPT or HCPCS code that specifies a time period for which it should be reported (e.g., weekly, monthly).



APPLICABLE CODES

The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies may apply.


CPT Code Description

93268

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation 93270 Recording (includes connection, recording, and disconnection) 93271 Transmission and analysis

93272 Review and interpretation by a physician or other qualified health care professional CPT® is a registered trademark of the American Medical Association QUESTIONS AND ANSWERS



1 Q: How does Oxford determine the “time span” for codes with a description of calendar month, per month or monthly?

A: The date of service (DOS) is the reference point for determining the frequency of code submission and subsequent reimbursement during that period. See the examples below: Calendar Month

CPT code 94005 (home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (e.g., assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan (as appropriate), within a calendar month, 30 minutes or more) is submitted March 13. The Same Group Physician and/or Other Health Care Professional reports this code for the same patient on April 5. Both codes are considered eligible for reimbursement as a Time Span Code because the service was provided in a different Calendar Month.


Per Month/or Monthly

HCPCS code A4595 [Electrical stimulator supplies, 2 lead, per month, (e.g. tens, nmes)] is submitted August 31. The Same Group Physician and/or Other Health Care Professional reports this code for the same patient on September 30. Both codes are considered eligible for reimbursement.

In order to consider reimbursement for services that may be repeated following a month with fewer than 31 days, Oxford may allow reimbursement of monthly time span codes when these codes are reported with dates of service at least 28 days apart.

2 Q: Does Oxford recognize modifiers, (e.g., 59, 76), through the Time Span Codes Policy to allow reimbursement for additional submissions of a code within the designated time span?

A: No. Reimbursement for codes included in the Time Span Codes Policy is based on the time span parameter specified in the code description, CPT book parentheticals and/or other coding guidance from the AMA or CMS.

Wednesday, May 10, 2017

CPT 99026, 99027, 99360, 99464


CPT Code Description

Non-Reimbursable

99026 Hospital mandated on call service; in-hospital, each hour

99027 Hospital mandated on call service; out-of-hospital, each hour

99360 Standby service, requiring prolonged physician attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG)


QUESTIONS AND ANSWERS

1 Q: If a pediatrician or other physician is requested by the delivering physician to attend at delivery and provide services to stabilize a newborn, are those services considered standby services?

A: No. If a physician is requested by the delivering physician to attend at delivery and to provide stabilization of a newborn, the physician may bill for those direct face-to-face services provided to the newborn using CPT code 99464.


APPLICABLE LINES OF BUSINESS/PRODUCTS

This policy applies to Oxford Commercial plan membership.

This reimbursement policy applies to services reported using the UB-04 claim form, the 1500 Health Insurance Claim Form (a/k/a CMS-1500), or their electronic equivalents or their successor forms. This policy applies to all network and non-network providers, including hospitals, ambulatory surgical centers, physicians and other qualified healthcare professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.



OVERVIEW

This reimbursement policy addresses reimbursement for standby services and hospital mandated on-call services.



Current Procedural Terminology

Per Current Procedural Terminology (CPT) definition, code 99360 is used to report physician or other qualified health care professional standby services that are requested by another individual that involves prolonged attendance without direct (face-to-face) patient contact. Care or services may not be provided to other patients during this period.

This code is not used to report time spent proctoring another individual. It is also not used if the period of standby ends with the performance of a procedure subject to a surgical package by the individual who was on standby.




REIMBURSEMENT GUIDELINES

Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) does not reimburse for physician standby services. These services are considered by CMS to be included in the payment to a facility as part of providing quality care and are not separately reimbursable.

Standby Services

In accordance with CMS, Oxford does not reimburse physician or other qualified health care professional standby services submitted with CPT code 99360. If a specific service is directly rendered to the patient by the standby physician or other qualified health care professional (i.e., tissue examination of frozen section biopsy), the service or procedure would be reported under the appropriate CPT code (i.e., 88331).


Mandated Hospital On-Call Service 

Oxford does not reimburse for hospital mandated on-call services billed under CPT codes 99026 and 99027 because they do not involve direct patient contact.

Friday, April 21, 2017

Denial code N290 AND N257



NPI: Troubleshooting Rejections

Denial Reason, Reason/Remark Code(s)

N257: Information missing/invalid in Item 33 - Missing/incomplete/invalid billing provider supplier primary identifier

N290: Information missing/invalid in Item 24J - Missing/incomplete/invalid rendering provider primary identifier


Resolution/Resources:

Each NPI must match one Provider Transaction Access Number (PTAN) on the NPI crosswalk file.

Step 1: If you contract with a billing service, find out if they have had communication with Palmetto GBA about NPI claim rejections. They may have important information that will help you resolve these claims.

Step 2: Verify the information on file with the NPI Enumerator. Call the NPI Enumerator at 800-465-3203 or access their website external link  to verify your information.


Pay special attention to the following fields in your NPPES record:

Each 'sole proprietor' should have an Individual (Entity Type 1) NPI and not an Organization (Entity Type 2) NPI
List your correct, current Medicare PTAN in the 'Other Provider Identifiers' section

If your NPI matches a PTAN that you no longer use (e.g., an old practice location), obtain and complete a new CMS-855 application and mail it to Palmetto GBA. Applications are available from the CMS 855 form external link  from the Enrollment Application Finder tool. We will be happy to assist you if you have questions about how to complete the application.


Step 3: If you are continuing to receive claim rejections after verifying information on file with the NPI Enumerator, verify the information you have on file with Palmetto GBA. Changes in this information require that you complete a new CMS-855 application.


Pay special attention to the Taxpayer Identification Number (TIN), which is used to report your income to the IRS on Form 1099


Consider consolidating multiple PTANs into a single number to ensure a one-to-one NPI to PTAN match. You may collapse PTANs that are assigned to additional locations only if the additional locations are all assigned the same TIN and are within the same pricing locality. More information about consolidating multiple PTANs is available in the CMS MLN Matters article MM5906
Step 4: Be aware of NPIs submitted for ordering/referring providers and attending/operating/other/service facilities

NPI numbers submitted in these fields must be valid. You may access the CMS NPI Registry to obtain these numbers.

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