Monday, March 31, 2003

Working with miscellaneous codes

Q. We have minimal success getting miscellaneous codes to pay. Do you have any helpful advice?

A. I agree that there are many pitfalls involved in getting miscellaneous codes to pay. Even if you get all the documentation required, you still run the risk of not being reimbursed adequately. Do the research and track your results.

Be very sure that the product you are trying to bill does not have an existing code. You can confirm this by contacting your supplier or by calling Medicare’s SADMERC.

When calling the coding line, have your provider number, manufacturer, and model or part number available.

When you have established there is no alternative, Medicare is very clear concerning what is required. Regardless of whether the equipment is a replacement part, such as a repair, or additional item billed along with a code, such as the versa tilt with a chair, Medicare always requires the same documentation.

You have to list the manufacturer, and model or part number for the product you are supplying. Then you have to list the same details for the item it goes along with. If the miscellaneous code is for a repair, you must state that it is for patient owned equipment. So be sure that it is. Now you have to prove medical necessity. In the case of a repair, it does seem self explanatory, but it is still required. Finally you must provide your cost price, not retail price.

You may try to bill miscellaneous codes electronically if you can fit all information in the HAO record. However, be prepared that even if you supply all documentation, Medicare may still want to see it in paper.

Ward Cook is president of Allegro Medical Billing. Reach him at 813-837-2773.