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
Amy Green: Mary Muchow: Amy Green: Mary Muchow: Amy Green: Mary Muchow: Amy Green: Mary Muchow: Operator: Mary Muchow: Natalie Murphy: Mary Muchow: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: OK. http://www.wpsmedicare.com And if you would put please ACT Topic Suggestion in the subject. Our staff and Medicare administration will then know who to forward the information to. OK, and that did work because that’s what I did and you did my questions so. OK, terrific. OK. My last question, and I don’t know if this is too claim specific, but it has to do with the RAC audits that have been happening with the observation care. I would like to give you a scenario and see what your thoughts are, is that something that you can answer on this teleconference I’m sorry; we’re not able to address that on this teleconference, Amy. OK. OK, that’s what I needed to know. Thank you very much. You’re welcome. Your next question comes from the line of Natalie Murphy. Hi, Natalie. Hi. I wanted to know, I don’t have a denial but I just have a hypothetical situation and that is when we do a VAD visit, which is the daily management of the VAD machine in the hospital, and the patient has had a previous, say, heart transplant. Do we a put a 24 modifier on that visit or a 79 saying I’m related, or just bill it as a plain visit as the 93750 I’m not familiar with the … did you say VAD visit Does anyone… Yes. Can you please repeat that question Let’s see, OK. Are you saying that the person who did the VAD … Yes. We put the VAD machine in, the ventricular assist device. OK. When we did that, maybe we did an aortic valve replacement. OK. But we see them everyday. Right. And after that, I know the valve replacement would be 90-day global. So do we put a 79 on the following daily visits after or… 6
Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: A 79 is for return to surgery. http://www.wpsmedicare.com I’m sorry, I mean a 24 modifier. No. What you’re describing is taking care of the patient in the typical postoperative care. So we shouldn’t be… Billing, no. Because that’s interrogation of the device in person and everyday, we see them until they get off the machine in order to get a heart transplant. That’s right. I believe that unless CMS gives you a zero global period, I mean, typically, when someone has a procedure done in the hospital, it is all the postoperative care in the hospital There are few exceptions like, a cauterization has a zero global period. But see, I can’t remember off the top of my head what the VAD CPT code is. It’s 93750 and Medicare has paid. Say we don’t do a procedure and we just insert the VAD machine and we see them daily, there’s no global for that 93750. So in that case, we do bill. Dr. Boren: 937… Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: Natalie Murphy: Dr. Boren: …50. No, but that’s not putting the VAD. No, we’ve already done that and everyday after we charge. What’s the CPT code for putting in a VAD It should be a 3 something. It is the 33979 – or a 33975, 76, 79. It depends on what type, bilateral or, you know. 33979. OK, that has a xxx global period. I’m trying to find the CMS – xxx global concept does not apply … Right. I have never heard of anyone billing. We do it everyday, yes. I see. We keep them on the machine. That is very interesting. 7
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Amy Green:<br />
Mary Muchow:<br />
Amy Green:<br />
Mary Muchow:<br />
Amy Green:<br />
Mary Muchow:<br />
Amy Green:<br />
Mary Muchow:<br />
Operator:<br />
Mary Muchow:<br />
Natalie Murphy:<br />
Mary Muchow:<br />
Natalie Murphy:<br />
Dr. Boren:<br />
Natalie Murphy:<br />
Dr. Boren:<br />
Natalie Murphy:<br />
Dr. Boren:<br />
Natalie Murphy:<br />
Dr. Boren:<br />
Natalie Murphy:<br />
OK.<br />
http://www.wpsmedicare.com<br />
And if you would put please <strong>ACT</strong> Topic Suggestion in <strong>the</strong> subject. Our staff<br />
and <strong>Medicare</strong> administration will <strong>the</strong>n know who to forward <strong>the</strong> information to.<br />
OK, and that did work because that’s what I did and you did my questions so.<br />
OK, terrific.<br />
OK. My last question, and I don’t know if this is too claim specific, but it has to<br />
do with <strong>the</strong> RAC audits that have been happening with <strong>the</strong> observation care. I<br />
would like to give you a scenario and see what your thoughts are, is that<br />
something that you can answer on this teleconference<br />
I’m sorry; we’re not able to address that on this teleconference, Amy.<br />
OK. OK, that’s what I needed to know. Thank you very much.<br />
You’re welcome.<br />
Your next question comes from <strong>the</strong> line of Natalie Murphy.<br />
Hi, Natalie.<br />
Hi. I wanted to know, I don’t have a denial but I just have a hypo<strong>the</strong>tical<br />
situation and that is when we do a VAD visit, which is <strong>the</strong> daily management<br />
of <strong>the</strong> VAD machine in <strong>the</strong> hospital, and <strong>the</strong> patient has had a previous, say,<br />
heart transplant. Do we a put a 24 modifier on that visit or a 79 saying I’m<br />
related, or just bill it as a plain visit as <strong>the</strong> 93750<br />
I’m not familiar with <strong>the</strong> … did you say VAD visit Does anyone…<br />
Yes.<br />
Can you please repeat that question<br />
Let’s see, OK.<br />
Are you saying that <strong>the</strong> person who did <strong>the</strong> VAD …<br />
Yes. We put <strong>the</strong> VAD machine in, <strong>the</strong> ventricular assist device. OK. When we<br />
did that, maybe we did an aortic valve replacement.<br />
OK.<br />
But we see <strong>the</strong>m everyday.<br />
Right.<br />
And after that, I know <strong>the</strong> valve replacement would be 90-day global. So do<br />
we put a 79 on <strong>the</strong> following daily visits after or…<br />
6
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