RA Messages for April 10, 2001
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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
NOTICE TO HOSPITALS
PLEASE NOTE: THE PROBLEM WITH REVENUE CODE 490 (AMBULATORY SURGICAL CARE)
CLAIMS DENYING IN ERROR WITH ERROR EDIT 266 (REVENUE CODE INVALID FOR AMBULATORY
SURGICAL PROCEDURE) OE EDIT 267 (REVENUE CODE 490 REQUIRES VALID ICD 9 SURGICAL
PROCEDURE) HAS BEEN CORRECTED.
CLAIMS THAT DENIED IN ERROR HAVE BEEN RECYCLED ON YOUR REMITTANCE ADVICE DATED
APRIL 1, 2001. IF YOU HAVE BEEN HOLDING NEW CLAIMS FOR REVENUE CODE 490
BECAUSE OF THIS PROBLEM, YOU MAY SUBMIT THEM NOW. WE APOLOGIZE FOR THE
INCONVENIENCE THIS HAS CAUSED. IF QUESTIONS ARISE, YOU MAY CALL PROVIDER
RELATIONS AT (800)473-2783 OR (225)924-5040.
PROVIDERS OF PROFESSIONAL SERVICES
CPT CODE 81000 (URINALYSIS), 82010 (ACETONE OR OTHER KEYTONE BODIES, SERUM;
QUANTITATIVE), 86683 (HEMOGLOBIN, FECAL), 87076 (ANAEROBIC ISOLATE, ADDITIONAL
METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE), 87339 (HELIOBACTOR
PYLORI), AND 87899 (INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT
OPTICAL OBSERVATION; NOT OTHERWISE SPECIFIED) ARE BEING ADDED TO THE LIST OF
PROCEDURES THAT REQUIRE A QW MODIFIER. CLAIMS ON WHICH THE QW MODIFIER IS
NOT ATTACHED WILL BEGIN TO DENY ON MAY 1, 2001. IF QUESTIONS ARISE, PLEASE
CONTACT TRACY ZIMMERMAN, PROGRAM SPECIALIST, AT (225)342-9319. YOUR
COOPERATION IS APPRECIATED.
PROVIDERS OF CRITICAL CARE SERVICES
PAGE 25-2 OF THE PHYSICIAN SERVICE MANUAL INDICATES THAT CPT CODES 93000, 93010, 93040, AND 93042 ARE INCLUDED IN CODES 99291 AND 99292.
THEREFORE, AT THIS TIME, THEY CANNOT BE BILLED SEPARATELY. THIS POLICY WAS MADE BEFORE THE DESCRIPTORS IN CPT LISTED THE CODES IN 99291 AND
99292 AND 99295-99298, HOWEVER, SO EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2001, PROVIDERS WILL BE ALLOWED TO BILL CPT CODES 93000, 93010,
93040, AND 93042 IN ADDITION TO 99291 AND 99292 AND/OR 99295-99298 ON THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT.
AS SOON AS PROGRAMMING CAN BE COMPLETED, THE PAYMENT OF CPT CODES 99291-99292 AND/OR99295 THROUGH 99298 FOR A RECIPIENT ON A PARTICULAR DAY WILL
RESULT IN THE DENIAL OF REIMBURSEMENT FOR COMPONENT CODES BILLED ON THE SAME DAY BY THE SAME OR DIFFERENT PROVIDERS FOR THE SAME RECIPIENT. CONVERSELY, THE OPPOSITE IS TRUE: IF A PROVIDER IS PAID FOR A COMPONENT
CODE(S) ON A GIVEN DAY FOR RECIPIENT A, REIMBURSEMENT FOR CODES 99291- 99292 AND/OR 99295-99298 ON THAT SAME DAY BY THE SAME OR ANY OTHER PROVIDER FOR RECIPIENT A WILL BE DENIED. THE COMPONENT CODES FOR EACH OF THESE CPT CODES CAN BE FOUND ON PAGES 331, 332, AND 389 OF THE 2001 CURRENT PROCEDURAL TERMINOLOGY.