Missing Device for CPT 21215?

kay.larsen@ah.org

Medical Surgery for CPT 21215

Billing edit for missing device

Autologous bone graft

How do I get past the billing edit? Use C1889 or C1762? Price at a penny?

Thanks!

Andrew.Reiten

Kay,

If no device was actually used that can be reported with any device HCPCS or HCPCS C1889, then append Modifier CG to CPT 21215.

See: https://www.cms.gov/medicare/coding-billing/outpatient-code-editor-oce/quarterly-release-files

Per the IOCE Manual (aka pbl021_IOCEV25.3_PC):

Effective 1/1/2019 (v20.3), certain device-intensive procedures codes are applicable for bypassing edit 92 if an insertion of a device is not completed (e.g., revision only). For the edit to be bypassed a device procedure on the "BYPASS_E92_MODIFIER" list is reported with modifier CG. For a list of applicable device procedures, reference the corresponding bypass column in the DATA_HCPCS table in the quarterly data files.

And per the IOCE Data_HCPCS file, CPT 21215 has a BYPASS_E92_MODIFIER of 1, so you can use Modifier CG.

Also see:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c04.pdf 

20.6.19 - Use of HCPCS Modifier - CG (Rev. 4513, Issued: 02-04-2020, Effective: 01-01- 2020, Implementation: 01-06-2020)

Effective January 1, 2019, the modifier –CG, “Policy criteria applied”, can be reported with certain device-intensive procedures to reflect situations in which a device was not used during the device-intensive procedure.

This modifier would be reported on the UB–04 form (CMS Form 1450) for hospital outpatient device-intensive procedures. Reporting of this modifier is not required for Critical access hospitals (CAHs). While this modifier is required, it does not have an effect on payment.

kay.larsen@ah.org

Thanks, will try.