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.
If you can adjust the value of 10763 on your EMR and you always do 3 biopsies, change the value to $19. This way 3 x $19 = $57 and you don’t have to manually change the value every time.
Great time saving tip Hamish!