billing questions consumables

[bedrock]

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In my new practice, the billing department is ok, but not everything I had hoped for. I've already caught a few mistakes, but I'm also not an expert in all aspects of billing.

One of the things I'm going to review with my charges is the consumables such as steroid etc. I know these are small charges, but they do add up over a month of procedures. So here are my questions.

1- I do 2/3 of my procedures in an ASC and 1/3 in an office setting. Can I charge for consumables such as steroid in the ASC or is that likely included in the facility fee?
2- At least in clinic or for office procedures I assume that I can charge for steroid for basically every procedure, correct? ESI, joint injections, nerve blocks, correct?
3- For which procedures can I bill for contrast? (Q9966) Is contrast included with all types of epidurals at this point? what about MBB? or sympathetic blocks? I assume that I can bill it for peripheral joint injections?
4- Can I still bill for Marcaine for lumbar MBB performed in the office? what about for nerve blocks in the office? If so, what is the J code for marcaine in this setting?

If I recall correctly, all these reimbursements are small, though steroid is worthwhile and definitely bigger than contrast/marcaine.

Thanks for your thoughts-

 

[Agast]

You can bill the J codes for your in office procedures, if you Google around you can find the J code for each and some of them are different based on mg used.

ASC procedures you’re only billing the CPT code for the procedure. The ASC should be submitting their own bill for the injectables and materials.

 

[bedrock]

You can bill the J codes for your in office procedures, if you Google around you can find the J code for each and some of them are different based on mg used.

ASC procedures you’re only billing the CPT code for the procedure. The ASC should be submitting their own bill for the injectables and materials.

i already considered that I could likely only bill consumables for office based procedures and I already googled all the J codes a long time ago.

My questions to the group really were about for which procedures can I still bill contrast (that its not already included)?
And is it still possible to bill marcaine for any procedure?

It is much harder to find the answer to those two questions with a web search.

 

[pmrmd]

1. In ASC u you bill your professional component.
2. Steroid for everything except ESI—it’s bundled.
3. Contrast for peripheral joints. It’s bundled for spine procedures.
4. Marcaine doesn’t reimburse. It has an s-code not a j-code.

 

[bedrock]

1. In ASC u you bill your professional component.
2. Steroid for everything except ESI—it’s bundled.
3. Contrast for peripheral joints. It’s bundled for spine procedures.
4. Marcaine doesn’t reimburse. It has an s-code not a j-code.

I thought that I could likely no longer bill for marcaine

Are you sure that I can't bill for steroid for an ESI? That would really limit the J code use if I can't even bill steroid for an ESI. I really didn't think steroid was bundled with ESIs.

Regarding contrast. I thought contrast was bundled in spine procedures for which fluoro was bundled, which is most of them, i.e ESI, MBB, RFA
But I thought you could still bill contrast for spine procedures that still had a separate fluoro code such as sympathetic blocks. So can't I still bill contrast for stellate and LSB? And can't I still bill both contrast and steroid for a ganglion impar?

And can't I still bill for steroid and contrast with a piriformis injection/sciatic block?

 

[promethius]

I noticed that most insurances I have been billing have still been paying for Q9966 with spinal procedures until recently. Only during the past few months have I noticed on explanations of payment that Medicare and some commercial insurances have stopped covering Q9966 with spinal procedures. Do you know when this change in the coverage of Q9966 officially took effect?

The comments on those explanations of payment for non-payment of Q9966 are that this code is not paid separately or is denied as it requires an accompanying procedure be billed and paid for on the same date-of-service. When I recently called Medicare about it, they told me that Q9966 is not covered at all anymore. Is that true or is it just bundled with certain (i.e. spinal) procedures? What procedures are now bundled with Q9966 and what procedures can we still bill separately with Q9966 and still have Q9966 paid for?

 

[BobBarker]

You are thinking about it in the wrong way. Bill for everything there is a code for in the office. You will get paid by the ones that cover it and not by the ones who don’t. Your billing will be the same for every payor/procedure. You don’t need to worry about what is bundled by one plan or another

I have a EOB in front of me where I was paid for betamethasone and contrast by a Medicare replacement plan.

 

[potcake76]

Bill for everything there is a code for in the office. You will get paid by the ones that cover it and not by the ones who don’t.

Pretty sure this is the opposite of correct.

 

[BobBarker]

I’m not saying to unbundle ultrasound, fluoro, epidurogram, etc. Don’t do that.

I’m saying bill every j and q code applicable. It is impossible to keep up with every plan and what they bundle in or not.

 

[10KHertz]

Yes you can bill j,s,q , and tray codes .
It’s up to your negotiated contracts and specific commercial/wc/ carriers. Most won’t pay much, but some do .

Don’t bill accessories for Medicare cases .

 

[painfree23]

Yes you can bill j,s,q , and tray codes .
It’s up to your negotiated contracts and specific commercial/wc/ carriers. Most won’t pay much, but some do .

Don’t bill accessories for Medicare cases .

Tray codes??

 

[10KHertz]

Tray codes??

Yes tray codes A code . Carve it out , few will pay

 

[painfree23]

Yes tray codes A code . Carve it out , few will pay

Wow, Seriously? CMS won’t , right? Also, do u have the exact code? How much is it reimbursed? Sorry for all the questions but my billers have never told me about this and now I’m gonna ask them.

 

[SpineandWine]

Re billing in office setting. Can you bill for asking someone to stop smoking? Or is that only for PCPs

 

[pmrmd]

Yes tray codes A code . Carve it out , few will pay

That was like a decade ago. Insurers stopped paying pretty quickly. Which payers still cover?

 

[10KHertz]

That was like a decade ago. Insurers stopped paying pretty quickly. Which payers still cover?

Pm me .

 

[deleted131481]

Re billing in office setting. Can you bill for asking someone to stop smoking? Or is that only for PCPs

I am HOPD and occasionally do 99406.

 

[BobBarker]

I bill 99406 when I think about it.

 

[painfree23]

I bill 99406 when I think about it.

Does it pay?

 

[BobBarker]

Yes

 

[Agast]

Bumping because I was not prepared for how expensive a 10-ml vial of Isovue is. $66 🙁

Man it’s really hard to come out ahead, it’s like every one has to take a chunk out of you

 

[nvrsumr]

Some gpos are a lot cheaper but i haven’t looked at cost recently

Also some docs sterilely draw up 10+ syringes of a multi dose vial in am before patients and place in sterile procedure bags with rest of supplies for each procedure etc. then toss the bottle. So one a day

 

[Agast]

I think you need a special sterile hood for that and maintain its certification. Unfortunately I don't think I have a room that I can use. I'm assuming it can't be inside the procedure room itself.

 

[Agast]

I suppose if a tree fell in the forest and no one was there to see it I could magically end up with 5 aliquots of 2cc syringes

 

[Ducttape]

im guessing some pain practices put a Dollar Tree portable fan in the room or just imagine a sterile hood and call it a day.

 

[bedrock]

Exactly. It’s a matter of common sense