RE: FW: Medicare Reimbursement for Evaluation of Swallow with Esophagram

[Guest guest]

This is something we got back in September last year to help clarify this issue.

Hope it helps.

PROBLEM WITH CORRECT CODING EDITS, VERSION 8.1,

REGARDING SLP MBS CODE AND RADIOLOGY CODE

Version 8.2 of the National Correct Coding Initiative (NCCI) edits, effective

July 1 * September 30, 2002, has corrected the inappropriate code pair edit

contained in version 8.1. ASHA was instructed in early May that, effective July

1, Medicare code G0196 (SLP participation in the MBS) would no longer be kicked

out when billed the same day as the MBS radiology code 74230, as was instructed

by NCCI version 8.1 (effective April 1).

Apparently, there will be a further delay before resubmitted G0196 claims will

be accepted by fiscal intermediaries. Based on the communication of July 10

(see below) from an NCCI coding specialist, the resubmissions will probably not

be accepted until October 1, 2002. The delay is due to the fact that hospital

outpatient prospective payment system (OPPS) NCCI edits run one quarter behind

the Part B edits. This is a rare situation where one code lies within OPPS and

the other code is external to OPPS. This is because all SLP/OT/PT services are

exempt from OPPS, even when rendered in a hospital outpatient setting. ASHA

has submitted a request that CMS allow denied hospital G0196 claims to be

accepted earlier than the release of the October 1, 2002 OPPS NCCI edits.

Ingrida Lusis

Director of Health Care Regulatory Advocacy

American Speech Language Hearing Association

phone: (301)571-0482

fax: (301)897-7356

email: ilusis@...