RA Messages for October 10, 2000

PHARMACY PROVIDERS, PLEASE NOTE!!!

IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790                                   

PLEASE MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

REFERENCING PAGE 24-15 OF THE PHYSICIAN SERVICES MANUAL, SPIROMETRY (CPT CODE 94010) IS A COMPREHENSIVE CODE THAT INCLUDES RESPIRATORY FLOW VOLUME LOOP (CPT CODE 94375). WHEN SPIROMETRY IS BILLED, RESPIRATORY FLOW VOLUME LOOP MAY NOT BE BILLED ON THE SAME DATE OF SERVICE BY THE SAME PROVIDER OR GROUP FOR THE SAME RECIPIENT.  BRONCHOSPASM EVALUATION (CPT CODE 94060) IS A COMPREHENSIVE CODE THAT INCLUDES SPIROMETRY AND RESPIRATORY FLOW VOLUME LOOP (CPT CODES 94010 AND 94375). THEREFORE, WHEN BRONCHOSPASM EVALUATION IS BILLED, NEITHER SPIROMETRY NOR RESPIRATORY FLOW VOLUME LOOP MAY BE BILLED ON THE SAME DATE OF SERVICE BY THE SAME PROVIDER OR GROUP FOR THE SAME RECIPIENT.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

CPT CODE 33140 (TRANSMYOCARDIAL REVASCULARIZATION - TMR) WILL PEND FOR MEDICAL REVIEW AND WILL BE PAID ONLY IF THE CRITERIA PRINTED IN THE 11-99 ISSUE OF THE MEDICARE PROVIDER NEWS ARE MET.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

CPT CODE 69990 (USE OF OPERATING MICROSCOPE), WHEN USED IN ADDITION TO CPT CODE 69436, WILL BE DENIED UNLESS THERE IS AN UNUSUAL SITUATION WHICH JUSTIFIES THE USE OF A MICROSCOPE. IF THE PROCEDURE APPEARS ROUTINE AND THE MICROSCOPE VISION IS JUST MENTIONED IN THE OPERATIVE REPORT, THE CLAIM WILL BE DENIED WITH AN ERROR CODE 774 (INCLUDED IN THE RELATED PROCEDURE).