09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare
09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare 09/11/12 Ask-the-Contractor Teleconference (ACT ... - WPS Medicare
Chere: Jim Williams: Mary Muchow: Jim Williams: Mary Muchow: Jim Williams: Mary Muchow: Jim Williams: Mary Muchow: Jim Williams: Mary Muchow: Jim Williams: Chere: Operator: Amy Green: Mary Muchow: Amy Green: Well, I can tell you that Dr. Boren and I have discussed this and we are going to put into the http://www.wpsmedicare.com low vision policy just a statement or a phrase stating that WPS realizes that fundus photography is used of broader ranges than included in this policy. And that might be something that you can give to Humana or whoever. But you would hope that they would note that themselves. Yes, that’s what I’m thinking and the way the LCD is written, it should exclude that procedure. But the fact that we’re still getting paid now that the new month had started, but the effective date was 8/20 of 2012, and we’re still getting paid on the side. I was just kind of preparing for the what if things change. Yes. This is Mary… You know, start of the new month so we’re starting to get denials, we’re just going to keep an eye on it. Right. Your next step would then to go back to the plan. Yes. I think that’s more of a Humana issue not… Correct. …and well I guess, we’ll just wait for the revision because that’s about the only place that I can find that particular procedure code, the 92250s, within the low vision LCD, so. OK. So we’ll, I guess, we’ll just kind of keep experimenting with it and if we have problems with it in the future, get back with you on that. All right. OK. Thank you very much. You’re welcome. Question comes from the line of Amy Green. Hi. Hi, Amy. I was told before that maybe the observation care was more claim specific. I just want to give you a scenario. It’s not directly related to one claim. What my question is, the family medicine physician admits a patient to observation at 1:33 am. Twelve hours later on the same day, an internal medicine doctor discharged patient. It is the same physician’s group but different specialties. Is it correct to bill 99219, which is an initial observation care for a family medicine physician, and 99217, which is an observation care discharge for 18
the internist, because they’re two different – with a different specialty and a different person, http://www.wpsmedicare.com but same group. Brett: Amy Green: Brett: Amy Green: Brett: Amy Green: Brett: Amy Green: Brett: Mary Muchow: This is Brett from Medical Review. We’re going to have to research that one a little bit more. And specifically, is it under 12 or over 12, did you say Over 12 hours. Over 12 hours Yes. I’ve taken this to, like, a tier two specialist and I still – there is nothing in the manual and so forth. We have all the guidelines from 30.6.8 from the manual that differentiates from when it’s a different specialty. OK and could I ask what PRRS specialist response you have received from them There was nothing in there because there was nothing that talks about different specialties. OK. We’ll research that, I’m sure you’re talking about in a different section not so much specific to that code about providers of the same specialty, same group are treated as one physician of the same day. But as far as – I would need some time to do some research in regards to the observation care codes and especially with the 12 over/under because I assume – obviously, one is that initial observation care and then the second one would be billing as a discharge. So I… Right. …need to research that a little bit more. Amy, can we get a telephone number from you And someone will follow up with you, please. Amy Green: Sure. It’s (563) 584-4170. Mary Muchow: Could you repeat the area code, please Amy Green: 563. Mary Muchow: Amy Green: Operator: Laurie Weber: OK, thank you. Thank you. Your next question comes from the line of Laurie Weber. Yes. I have a question about the multiple E/M codes in on a single day also. What qualifies a different group Is that you’re billing under a different NPI or a different tax ID number Can you clarify that for us 19
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- Page 3 and 4: for a new pricing on the influenza
- Page 5 and 6: Mary Muchow: Operator: Mary Muchow:
- Page 7 and 8: Dr. Boren: Natalie Murphy: Dr. Bore
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Chere:<br />
Jim Williams:<br />
Mary Muchow:<br />
Jim Williams:<br />
Mary Muchow:<br />
Jim Williams:<br />
Mary Muchow:<br />
Jim Williams:<br />
Mary Muchow:<br />
Jim Williams:<br />
Mary Muchow:<br />
Jim Williams:<br />
Chere:<br />
Operator:<br />
Amy Green:<br />
Mary Muchow:<br />
Amy Green:<br />
Well, I can tell you that Dr. Boren and I have discussed this and we are going<br />
to put into <strong>the</strong> http://www.wpsmedicare.com<br />
low vision policy just a statement or a phrase stating that <strong>WPS</strong><br />
realizes that fundus photography is used of broader ranges than included in<br />
this policy. And that might be something that you can give to Humana or<br />
whoever. But you would hope that <strong>the</strong>y would note that <strong>the</strong>mselves.<br />
Yes, that’s what I’m thinking and <strong>the</strong> way <strong>the</strong> LCD is written, it should exclude<br />
that procedure. But <strong>the</strong> fact that we’re still getting paid now that <strong>the</strong> new<br />
month had started, but <strong>the</strong> effective date was 8/20 of 20<strong>12</strong>, and we’re still<br />
getting paid on <strong>the</strong> side. I was just kind of preparing for <strong>the</strong> what if things<br />
change.<br />
Yes. This is Mary…<br />
You know, start of <strong>the</strong> new month so we’re starting to get denials, we’re just<br />
going to keep an eye on it.<br />
Right. Your next step would <strong>the</strong>n to go back to <strong>the</strong> plan.<br />
Yes. I think that’s more of a Humana issue not…<br />
Correct.<br />
…and well I guess, we’ll just wait for <strong>the</strong> revision because that’s about <strong>the</strong><br />
only place that I can find that particular procedure code, <strong>the</strong> 92250s, within<br />
<strong>the</strong> low vision LCD, so.<br />
OK.<br />
So we’ll, I guess, we’ll just kind of keep experimenting with it and if we have<br />
problems with it in <strong>the</strong> future, get back with you on that.<br />
All right.<br />
OK. Thank you very much.<br />
You’re welcome.<br />
Question comes from <strong>the</strong> line of Amy Green.<br />
Hi.<br />
Hi, Amy.<br />
I was told before that maybe <strong>the</strong> observation care was more claim specific. I<br />
just want to give you a scenario. It’s not directly related to one claim. What<br />
my question is, <strong>the</strong> family medicine physician admits a patient to observation<br />
at 1:33 am. Twelve hours later on <strong>the</strong> same day, an internal medicine doctor<br />
discharged patient. It is <strong>the</strong> same physician’s group but different specialties.<br />
Is it correct to bill 99219, which is an initial observation care for a family<br />
medicine physician, and 99217, which is an observation care discharge for<br />
18
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