coding (ICD, CPT, HCPCS)

ICD

ALL diagnoses must be recorded in the health care record including primary, secondary, and any additional diagnoses.

All ICD Codes reported to a HNS contracted payor must be properly documented and must support the necessity of care billed, and must be consistent with the patient's chief complaint, clinical findings and treatment plan.

ICD codes reported on insurance claims must be consistent with HNS and HNS payor policies, the policies of applicable licensing boards, as well as state and federal laws.

Providers must use the most accurate and appropriate ICD code for services reported on an insurance claim.

Only valid ICD-9 codes should be reported on insurance claims submitted through HNS.

CPT

Providers must assure that the CPT codes reported on the insurance claim accurately reflect the services provided and that such services are properly documented in the health care record

Only CPT codes that reflect services that are medically necessary, consistent with the patient's chief complaint, clinical findings, diagnoses and treatment plan should be reported on claims filed through HNS.

CPT codes reported on insurance claims filed through HNS must be consistent with HNS and HNS payor policies, the policies of applicable licensing boards, as well as state and federal laws.

Providers must use the most accurate and appropriate CPT code for services reported on an insurance claim.

Only valid ICD-9 codes should be reported on insurance claims submitted through HNS.

HCPCS

HNS providers must accurately report the correct HCPCS code on all insurance claims filed through HNS.

HCPCS codes can only be billed to a HNS contracted payor if the services is medically necessary, consistent with the patient's chief complaint, clinical findings, diagnoses and treatment plan.

HCPCS codes can only be billed to a HNS contracted payer if the service is consistent with HNS and HNS contracted payor corporate medical policies, the policies of applicable licensing boards, as well as state and federal laws.

All DME services provided must be documented in the health record.

Many HCPCS codes are not covered by HNS contracted payors, so in addition to verifying benefits, please check the applicable payor corporate medical policy and/or contact your HNS Provider Rep if you have questions or need assistance.

Documentation in the health care record must include the specific DME recommended, the date the DME was ordered and the date the DME was delivered to the patient.  Proof of purchase of the DME, unless rented, must be available upon request, if requested by a contracted payor or HNS.  Rental agreements for DME must be available upon request, if requested by a contracted payor or HNS.

Documentation in the health care record should include all instructions given to the patient regarding the use of any DME.  If written standards are maintained for DME that include specific instructions, reference to the written standard is acceptable.  If written standards for DME are utilized, they should include the following statements:

The patient's health care record clearly establishes the medical necessity for any DME billed to the payor.

The need for any DME billed to a payor is consistent with the patient's chief complaint, clinical findings, diagnosis and treatment plan.

Billing for Electrodes used during electrical stimulation

Electrodes are considered incidental to electrical stimulation by all HNS contracted payors.  Accordingly, it is inappropriate to bill for electrodes when performing electrical stimulation. 

 

BCBSNC Corporate Medical Policy for Bundling

Electrical Stimulation  / Electrodes –

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement is not allowed for incidental supplies.

  

CIGNA Corporate Medical Policy Code Editing

Electrical Stimulation  / Electrodes –

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement is not allowed for incidental supplies.

Modifiers

When applicable, providers must use appropriate modifiers when reporting and billing for chiropractic services billed to a HNS contracted payor.  The use and/or need for the modifier must be supported by appropriate documentation in the health care record.