Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder about how healthcare providers should use qualifiers for ICD-10 diagnosis codes submitted on electronic claims.

CMS notes that when you submit electronic claims for services, remember the following:

  • Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10.
  • Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can use ICD-9.

Use ICD-10 qualifiers as follows:

  • For ASC X12 837P 5010A1 claims, the HI01-1 field for the Code List Qualifier Code must contain the code "ABK" to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code "ABF" for the Code List Qualifier Code to indicate up to 11 additional ICD-10 diagnosis codes that are sent.
  • For ASC X12 837I 5010A1 claims, the HI01-1 field for the Principal Diagnosis Code List Qualifier Code must contain the code "ABK" to indicate the principal ICD-10 diagnosis code being sent. When sending more than one diagnosis code, use the qualifier code "ABF" for each Other Diagnosis Code to indicate up to 24 additional ICD-10 diagnosis codes that are sent.
  • For NCPDP D.0 claims, in the 492.WE field for the Diagnosis Code Qualifier, use the code "02" to indicate an ICD-10 diagnosis code is being sent.

For more assistance with ICD-10, check out the practice management tools from PGM Billing, a leading electronic medical billing service provider.

The Centers for Medicare & Medicaid Services (CMS) has recently published a revised fact sheet on telehealth services.

The fact sheet provides information about originating sites; distant site practitioners; telehealth services; and billing and payment for professional services furnished via telehealth and the originating site facility fee.

Here is some important background information on telehealth services.

Telehealth Services Overview

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

An originating site is the location of an eligible Medicare beneficiary at the time the service furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:

  • A rural health professional shortage area (HPSA) located either outside of a metropolitan statistical area (MSA) or in a rural census tract; or
  • A county outside of a MSA.

Originating sites authorized by law are:

  • offices of physicians or practitioners;
  • hospitals;
  • critical access hospitals (CAH);
  • rural health clinics;
  • federally qualified health centers;
  • hospital-based or CAH-based renal dialysis centers (including satellites);
  • skilled nursing facilities; and
  • community mental health centers (CMHCs).

Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to state law) are:

  • physicians;
  • nurse practitioners (NPs);
  • physician assistants (PAs);
  • nurse-midwives;
  • clinical nurse specialists (CNSs);
  • certified registered nurse anesthetists;
  • registered dietitians or nutrition professionals; and clinical psychologists (CPs) and clinical social workers (CSWs). Note: CPs and CSWs cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for CPT codes 90792, 90833, 90836, and 90838.

As a condition of payment, physicians or practitioners at the distant site must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the beneficiary at the originating site.

If your organization requires assistance with billing for telehealth services, contact medical billing company PGM Billing. PGM is a leading integrated physician billing, practice management and electronic medical record service that provides highly efficient medical claims processing that helps healthcare providers improve their collections and cash flow, while gaining valuable insight into their organization's performance.

X