General Question for the Week of May 22, 2017

General Compliance Question of the Week

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?

Answer:

You are correct; the answer we provided was not the current policy, and we apologize for any inconvenience caused.

Detailed information about reporting and charging requirements when a device is furnished without cost to the hospital or when the hospital receives a full or partial credit for the replacement device can be found in the Medicare Claims Processing Manual, chapter 4, section 61.3.5 and 61.3.6 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf. This policy took effect on January 1, 2014.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.