Device to Procedure Edits (Harvested bone)

hdubois@lifespan.orghdubois@lifespan.org
in BILLING AND CLAIMS

Hello-

Has anyone else had the challenge of getting a device to procedure edit & subsequent denial because a payor is looking for an implant charge; but the material was obtained from the patient?

Comments

  • Andrew.ReitenAndrew.Reiten

    I haven't had the same exact situation, but I have had other device intensive procedures without devices issues. There are a couple of options, illustrated in CMS IOCE (https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs) that might help: adding Modifier CG to the procedure code if listed on the "BYPASS_E92_MODIFIER" list or using HCPCS C1889 as the device code, perhaps with a token charge (less than 1.01) if there was no cost. See also, the Medicare Claims Processing Manual, Chapter 4, Section 20.6.19.

  • hdubois@lifespan.orghdubois@lifespan.org

    Hi Andrew- Thank you so much for this, we ended applying to C1889 with a token charge of $0.10 and this was reimbursed (this was a commercial claim). When we used CG they sent the claim back, but we have had look with Medicare claims and that code.

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