Billing tips for new Upper Endoscopy Fees

   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                        

         NOTES:                                                                

         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%                

TIPS:                                                                           

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             

        NOTES:                                                                 

        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.