Procedure to Procedure edit
50010/0213T indicated Misuse of column two codes with column one code meaning 50010 in column 1 is the code that should be bill and is payable. 0213T located in column 2 of the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) code table. The main reason beyond the implementation of the NCCI is to prevent improper payment in other words to prevent physicians, non-physician practitioners, and Ambulatory Surgery Centers from billing twice for one service or combining service that should not be billed at the same time on a patient
CPT Code 50010 is used for Surgical Procedures on the Kidney while 0213T CPT Code. Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves …show more content…
Medical Unlikely Edits
Medically Unlikely Edits (MUEs) – there is a maximum number of unit of service that is allow to be billed for s single HCPSC/CPT code for a beneficiary on a date of service thus accurate billing is critical to prevent payment been denied.
CPT code 0051T - Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy which allow 1 unit of service for example a provider bill for more than one unit of service MUE prevents the payment from processing. In other words a Practitioner can only do 1 heart replacement for a single beneficiary in a day. He/she cannot bill for 2 heart transplant on Mr. John Doe on November 1, 2017.
Pass-through drugs
Drugs that are usually too new to be well characterized in the data used to set payments rates. They received a pass through payment status usually for two years but not exceeding three years. According to CMS website Congress established the pass through provision in the Medicare law in an effort to encourage the circulation of new drugs this will help to boost the use of new
50010/0213T indicated Misuse of column two codes with column one code meaning 50010 in column 1 is the code that should be bill and is payable. 0213T located in column 2 of the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) code table. The main reason beyond the implementation of the NCCI is to prevent improper payment in other words to prevent physicians, non-physician practitioners, and Ambulatory Surgery Centers from billing twice for one service or combining service that should not be billed at the same time on a patient
CPT Code 50010 is used for Surgical Procedures on the Kidney while 0213T CPT Code. Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves …show more content…
Medical Unlikely Edits
Medically Unlikely Edits (MUEs) – there is a maximum number of unit of service that is allow to be billed for s single HCPSC/CPT code for a beneficiary on a date of service thus accurate billing is critical to prevent payment been denied.
CPT code 0051T - Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy which allow 1 unit of service for example a provider bill for more than one unit of service MUE prevents the payment from processing. In other words a Practitioner can only do 1 heart replacement for a single beneficiary in a day. He/she cannot bill for 2 heart transplant on Mr. John Doe on November 1, 2017.
Pass-through drugs
Drugs that are usually too new to be well characterized in the data used to set payments rates. They received a pass through payment status usually for two years but not exceeding three years. According to CMS website Congress established the pass through provision in the Medicare law in an effort to encourage the circulation of new drugs this will help to boost the use of new