Please take note of several new fees. These are retroactive to November 29, 2013. To rebill retroactively after 90 days use submission code “A”.
Hamish Hwang, Economics
New MSP fees take effect on April 1, 2013. Please download these from teleplan if you haven’t done so already on your EMR. There are several other minor fee increases you may notice.
71630 – use of mesh for hernia repair – extra
This is now $27.22 but can be billed with 71606, 71607 and 71608, effective immediately.
P71630 Use of mesh for hernia repair – extra………………………………………… $27.22
The following fees are effective immediately. They will not appear on the MSP broadcast until April 15 but should download from teleplan onto your EMR.
P71010 – complex consultation for management of malignancy ……………………….. $125.50
P71017 – Special office visit for new diagnosis or recurrent malignancy …………….. $47.64
Please bill only for histologically proven malignancy, not including non-melanoma skin cancer. If this fee is overbilled the fee value will be decreased after the 18 month monitoring period.If you see a patient with “suspected” cancer bill 07010. You can then bill 71017 for the subsequent office visit when cancer is proven. Please see the attached “minute of the commision” for the fee descriptions.
Please use one of the following appropriate diagnostic codes with the new fees:
151 stomach cancer
153 colon cancer
154 rectal cancer
155 liver cancer
156 bile duct cancer
157 pancreas cancer
174 breast cancer
193 thyroid cancer
195 misc cancer
199 misc cancer
You will notice the fee for 07010 has gone back down to $97.77. The reason it was temporarily increased was because 71010 could not be billed retroactively to April 1, 2012. Now that the new fee 71010 is in effect the money has been transferred to the new fee.
Economics, Section of General Surgery
07001 can only be billed with the recently created upper GI surgical fees.
Please refer to the fee guide for the complete list of fees eligible for 07001
For those using Accuro EMR I’ve uploaded the new SSC complex discharge plan template to be downloaded from the form publisher
Just search for “SSC” and the form is called “SSC complex discharge plan”
You will need to change my name to yours
There is more info about the fee on the bcma website: bcma.org
The fee is effective June 1, 2012
Bill 07999 with a value of $43.44 when you fill tissue expanders for out plastic surgeon colleagues.
Make sure you enter a note record: “injection-tissue expander-breast reconstruction”
This is just a copy of the MSP info on billing tips for the new endoscopy fees. This can help avoid rejections/delays.
BILLING TIPS FOR SP10763 AND SP10764
BILLING TIPS TO HELP EXPEDITE PROCESSING AND AVOID REFUSALS FOR FEE ITEMS SP10763 AND SP10764.
SP10763 INITIAL ESOPHAGEAL, GASTRIC OR DUODENAL BIOPSY
I) PAID ONLY IN ADDITION TO SP10761, SP10762 AND SY10750
TO A MAXIMUM OF THREE BIOPSIES PER ENDOSCOPY, IN ONE ORGAN OR MULTIPLE ORGANS.
II) FIRST BIOPSY PAID AT 100%, SECOND AND THIRD AT 50%
TO EXPEDITE PROCESSING, WHEN BILLING FOR MULTIPLE BIOPSIES, MSP ENCOURAGES THE CLAIMS BE SUBMITTED ON ONE LINE OR DETAIL WITH MULTIPLE SERVICES AT THE CORRECT AMOUNT, NO NOTE IS REQUIRED.
EG. 2 X 10763 @ $42.75 (=$28.50 + $14.25)
3 X 10763 @ $57.00 (=$28.50 + $14.25 + $14.25)
IF YOUR SYSTEM CANNOT BILL FOR MULTIPLE AT THE CORRECT PERCENTAGES YOU CAN BILL AS MULTIPLES AT THE FULL AMOUNT, NO NOTE REQUIRED. THERE MAY BE A DELAY IN PROCESSING.
EG. 2 X 10763 @ $57.00 (MSP WILL ADJUST TO $42.75 = $28.50 + $14.25)
3 X 10763 @ $85.50 (MSP WILL ADJUST TO $57.00 = $28.50 + $14.25 + $14.25
TO AVOID REFUSALS ON YOUR CLAIM, IF YOU CHOOSE TO BILL EACH CLAIM ON A SEPARATE LINE, PLEASE ENSURE THE SECOND OR THIRD CLAIM HAS A SUBMISSION CODE D AND APPLICABLE NOTE RECORD.
EG. 1 X 10763 @ $28.50
1 X 10763 @ $14.25 SUBMISSION CODE D AND NOTE “SECOND BIOPSY”
1 X 10763 @ $14.25 SUBMISSION CODE D AND NOTE “THIRD BIOPSY”
SP10764 MULTIPLE BIOPSIES FOR DIFFERENTIAL DIAGNOSIS OF BARRETT’S ESOPHAGUS, H PYLORI, EOSINOPHIIC ESOPHAGITIS, INFECTION OF STOMACH, SURVEILLANCE FOR HIGH OR LOW GRADE DYSPLASIA, OR CARCINOMA
I) PAID ONLY ONCE PER ENDOSCOPY
II) PAID ONLY IN ADDITION TO SP10763 AT 100%
III) ONLY APPLICABLE TO SERVICES SUBMITTED UNDER DIAGNOSTIC CODES 530, 041, 235, AND 234.9.
TIP: CLAIMS FOR THIS FEE IS ONLY APPLICABLE FOR SERVICES SUBMITTED UNDER THE APPLICABLE DIAGNOSTIC CODES LISTED IN NOTE III) UNDER THE FEE ITEM.
You can also get it under Events then click on 2012 Annual General Meeting
Download your black and white printable version here:
Care to share some billing pearls? Do you have a question on how to bill a complex case? Post your tips and questions here.