UGS/WPS CLMA Quarterly Minutes JULY 19, 2002 Attendees: Paul Hable Mike Lawton Monique Fourrier Kathy Lundeen Debbie Christian Jo Ann Lang Sue Jahane Beth Stenklyft Teena Wigley Discussion: Scenarios regarding billing of labs to Part A and B. A request was made by Monique to have them e-mailed to her. Then Monique and Teena will collaborate on the answers as needed. Why would Magnesium be paid under Part B for DX 585, but not payable under Part A? It makes a difference what lab we send our O labs to. Answer: Yes, the policy are different if you have a code that you want the medical director of UGS, LLC to consider please submit the code and documentation on why you think the code should be added to: Carol Covelli United Government Services, LLC. 401 W. Michigan Street C-3 Milwaukee, WI 53203-2804 Open Action Item: 1. Would the hospital ever have to put a TC modifier on a CPT code billed to Medicare? If, for instance, during a cardiac cat the physician using the 26 modifier bills the injection and supervision and interpretation codes would the hospital have to append the TC modifier to those codes? Is there a resource available on how to clearly use the TC modifier (AB-01-047 is not clear)? Answer: Per CMS Region V Policy Department, the technical component of a service is the actual performance of the test. It does not require the expertise of a physician. Normally, the office staff or hospital performs the technical portion of the test. If a code showing “tracing only, without interpretation and report“ is not available, use the global procedure code with modifier TC, technical component. When a technical service is rendered in a hospital inpatient or outpatient setting, nursing facility or comprehensive outpatient rehabilitation facility (CORF), Medicare Part B does not pay for it. The cost is submitted to Medicare Part A by the facility. Technical services rendered in an ambulatory surgery center (ASC) are not covered as a charge separate from the facility fee. They are included in the reimbursement of the facility fee charge. Questions and Answers for July 19, 2002 meeting: 1. When laceration repair is done, is it appropriate to bill splint/strapping charges as well if (repair is) performed? Answer: UGS would like an example if possible please supply a HIC number and date of service. 2. Will UGS and WPS have their LMRPs in line with National Coverage Decisions arrived at through the negotiated rulemaking by the November 25, 2002 start date and will your computers be set to audit claims accordingly? Answer: Yes, the LMRPs that UGS has will retire when the national policy becomes effective. As for editing, it will be consistent nationally. Please refer to PM AB-02-87. 3. Please review again when the modifiers for multiple procedures should be used for services provided on the same day. Outline the difference in how it should be handled for UGS claims. Answer: Modifier 91 is used for test that are performed more than once on the same day for the same patient, only when it is necessary to obtain multiple results in the course of treatment. This modifier may not be used when tests are re-run to confirm initial results, due to testing problems with specimens or equipment, or any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when there are standard HCPCS codes available that describes the series of results (e.g., glucose tolerance tests, evocative/suppression testing, etc). This modifier may only be used for laboratory tests paid under the clinical diagnostic laboratory fee schedule. Modifier 76 is used to indicate that a procedure: Use when a procedure is repeated – In a separate session On the same day By the same physician The procedure repeated must be the same procedure (same HCPCS code) May be used in surgery, radiology, and other diagnostic test Modifier 59 is used for distinct procedural services: Use for services not normally reported together Use to indicate a service distinct or independent from other services performed on the same day Use to represent (not ordinarily performed on the same day): Different procedure Different site or organ system Separate incision Separate injury (or area or injury in extensive injuries) Do not use if a level II modifier can be used. May be used with surgery, radiology and other diagnostic test