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What's New and Happening
Coding
ICD-9 Vs ICD-10
First and foremost make sure your software program can handle the new
length. ICD-9 codes are a maximum of 5 characters. ICD-10 however can be up
to 7 characters. The ICD-10 codes can be viewed as combining a DX 1 and DX 2
code. Many of these codes are both symptom and cause. This allows the
insurance and government intermediaries to have less human interaction and
create stricter payment guidelines. The ICD-9 codes have over 13,000 codes
right now. The ICD-10 codes have 68,000 codes. These will not be an easy 1
to 1 match. Your 1 ICD-9 code could have 5 possible matches. It is important
that you do not wait until the last minute to start putting these in. It may
take a couple of years to implement but if you start now, than you are ready
and your employees will have lots of time to learn the system. These codes
will even specify left and right so your modifiers will have to match as
well.
Medicare
Remember when billing a replacement accessory for a main piece of equipment
to use the RB modifier, and in box 19 of the 1500 claim form provide a
detailed explanation as to why it is being replaced.
Prepayment Review
Medicare is conducting a widespread review of claims. Supplies of a selected
claim will receive an ADR (Additional Documentation Request) letter asking
for specific information to determine if the item billed complies with the
existing reasonable and necessary criteria. You will have 30 days for the
date of the letter to respond or the claim will be denied as NOT medically
necessary.
The following codes are now under review
E0731 - Form fitting conductive garment for delivery of TENS or NMES (with
conductive fibers separated from the patient's skin by layers of fabric).
E0277 - Powered pressure-reducing mattress.
A5500 - For diabetics only, fitting (including follow-up), customer
preparation and supply of off-the-shelf depth-inlay shoe manufactured to
accommodate multi-density insert(s), per shoe.
A5512 - For diabetics only, multiple density insert(s), direct formed,
molded to foot after external heat source of 230 degrees Fahrenheit or
higher, total contact with patient's foot, including arch, base layer
minimum of ¼ inch material of Shore A 35 Durometer or 3/16 inch material of
Shore A 40 Durometer (or higher), prefabricated, each.
E0601- Continuous airway pressure (CPAP) device.
Medi-Cal
Remember to check the Suspended and Ineligible Provider List to see any of
your referring providers are on it. If they are your claims will be denied.
CalViva Health will be the local initiative and Anthem Blue Cross will be
the commercial plan in Fresno, Kings, and Madera counties. You must
subcontract with each to service their beneficiaries. CalViva 888-893-1569.
Anthem Blue Cross 877-811-3113
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