Compliance Question of the Week

For the Week of May 22, 2017

Cardiology

Cardiology Question for the Week of May 22, 2017

Question:

When it is billed, does For LUMASON® (sulfur hexafluoride lipid-type A microsphere) for injectable suspension, for intravenous use or intravesical use need a separate diagnosis, or is it covered under the primary reason the echo was ordered? Previously (ICD- 9) we used 794.39 (abnormal result of other cardiovascular function study) to bill for any enhancer used during an echo. Should we still be doing this with the new ICD-10 code R94.39 (abnormal result of other cardiovascular function study)?

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Laboratory

Laboratory Question for the Week of May 22, 2017

Question:

Does Medicare reimburse ESRD-related laboratory tests?

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Pharmacy

Pharmacy Question for the Week of May 22, 2017

Question:

What modifiers are required for claims submitted for ESAs administered to non-ESRD patients (J0881 and J0885)?

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Radiology

Radiology Question for the Week of May 22, 2017

Question:

What code(s) do we report for contrast-enhanced ultrasound for vesicoureteral reflux?

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Respiratory

Respiratory Question for the Week of May 22, 2017

Question:

Can respiratory therapists (RTs) perform smoking and tobacco-use cessation counseling services for Medicare patients? Since the RTs really don’t submit claims, can the hospital bill a technical component if the services are performed by an RT under physician order (i.e., under the Medicare incident-to policy)?

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General

General Question for the Week of May 22, 2017

Question:

I have a comment to the answer posted to an April 10 question. You stated that, according to the Centers for Medicare & Medicaid Services (CMS), there is no cost to the hospital for a device being inserted and that modifier –FB must be appended to the procedure code (not the device code) under certain circumstances.

I had thought -FB was no longer a CMS requirement; rather the facility should utilize the correct condition code as well as the amount of credit in the “FD” value code?

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