Billing Codes

I am not a pessimist--I remember stuff.

Fourbtgait wrote: ↑

Fri Mar 03, 2023 6:54 pm

That number is referenced on ResMed medicare numbers.
Did you find it on a different document?

---------------------> https://www.aapc.com/codes/hcpcs-codes/K0739

ChicagoGranny wrote: ↑

Fri Mar 03, 2023 7:40 pm

Fourbtgait wrote: ↑

Fri Mar 03, 2023 6:54 pm

That number is referenced on ResMed medicare numbers.
Did you find it on a different document?

---------------------> https://www.aapc.com/codes/hcpcs-codes/K0739

Very nice, thank you. Though I notice top of the web page it talks Medicare again, I probably should submit using that number and see what they say.

The worst they could do is say No--again.

Fourbtgait wrote: ↑

Fri Mar 03, 2023 10:25 pm

Though I notice top of the web page it talks Medicare again

Medicare, Medicaid, and private health insurers use these codes. They are HCPCS codes. HIPAA requires the use of HCPCS codes. Health insurance companies do not have their own codes.

ChicagoGranny wrote: ↑

Sat Mar 04, 2023 8:02 am

Fourbtgait wrote: ↑

Fri Mar 03, 2023 10:25 pm

Though I notice top of the web page it talks Medicare again

Medicare, Medicaid, and private health insurers use these codes. They are HCPCS codes. HIPAA requires the use of HCPCS codes. Health insurance companies do not have their own codes.

My daughter who works in billing in a New England hospital concurs with this. The codes are standardized for both commercial insurance and Medicare.

It would seem to me a doctor or other medical professional would need to authorize a repair (or replacement) of equipment and it would be the that person who also provides the correct coding. Otherwise what would stop people from simply buying or being given a broken CPAP, sending it to a repair facilities with a code, and having insurance pay to have it repaired? I can't just go to a hospital and give an xray tech a code, have my foot xrayed, and expect to have insurance pay. A doctor orders up the xray and provides the coding to the xray department folks.

Grumpy48 wrote: ↑

Sat Mar 04, 2023 9:22 am

It would seem to me a doctor or other medical professional would need to authorize a repair (or replacement) of equipment and it would be the that person who also provides the correct coding. Otherwise what would stop people from simply buying or being given a broken CPAP, sending it to a repair facilities with a code, and having insurance pay to have it repaired? I can't just go to a hospital and give an xray tech a code, have my foot xrayed, and expect to have insurance pay. A doctor orders up the xray and provides the coding to the xray department folks.

I wasn't going to say it, but given the information provided, what Fourbtgait is doing seems squirrely.

viewtopic.php?f=1&t=185339&p=1424141#p1424141

Found this: https://www.cms.gov/medicare-coverage-d ... de%20E0601.

For E0467 claims with dates of service on or after April 3, 2020:

Any claim for repair (HCPCS code K0739 for labor and any HCPCS code for replacement items) of beneficiary-owned equipment identified by HCPCS codes listed above is considered as unbundling if the date(s) of service for the repair overlaps any date(s) of service for code E0467.

Claims for code E0467 with a date(s) of service that overlaps date(s) of service in a rental month for any of the items listed above are considered as a claim for same or similar equipment.

So yes, K0739 appears to the HCPCS code for repairs.

I was curious about the term "unbundling". Apparently:

What is the CMS definition of unbundling?
WHAT IS UNBUNDLING? “Unbundling” is a form of medical billing fraud that is similar to upcoding. In unbundling, medical providers bill complex, multi-step procedures separately, instead of as one coded procedure. Billing the steps individually allows the provider to recover more reimbursement for the same services.

I'm curious why CMS prohibits unbundling of services while permitting unbundling of supplies (parting out masks)?

So, the codes are universal.
Thank you!
And the approval of a professional is necessary for payment by insurance.
That totally makes sense!
As for the unbundling question--somehow the integrated humidifier
is billed separately--just shows how much shady stuff gets pushed through.
---just not for the benefit of the PATIENT!

ChicagoGranny wrote: ↑

Sat Mar 04, 2023 10:03 am

Grumpy48 wrote: ↑

Sat Mar 04, 2023 9:22 am

It would seem to me a doctor or other medical professional would need to authorize a repair (or replacement) of equipment and it would be the that person who also provides the correct coding. Otherwise what would stop people from simply buying or being given a broken CPAP, sending it to a repair facilities with a code, and having insurance pay to have it repaired? I can't just go to a hospital and give an xray tech a code, have my foot xrayed, and expect to have insurance pay. A doctor orders up the xray and provides the coding to the xray department folks.

I wasn't going to say it, but given the information provided, what Fourbtgait is doing seems squirrely.

viewtopic.php?f=1&t=185339&p=1424141#p1424141

Squirrelly?
I have a valid prescription from my doctor for machine, supplies etc.
Said prescription does not have codes on it which is normal.
I bought items after getting the machine 5 years ago through local distributor, through 3rd party, had machine repaired, paid cash. Said machine on original invoice has matching serial number on repair invoice. Decided for once to run it through insurance.
So what is squirrelly about that?

Thank you others for verifying codes are codes. That was my initial question and it appears many did not realize the same

Fourbtgait wrote: ↑

Sun Mar 05, 2023 10:09 pm

So what is squirrelly about that?

Repairing a five-year-old machine is squirrely.

If your insurance company figures out how old it is, you are unlikely to get reimbursed. (Although, some insurance companies have temporarily liberalized their practices due to the market shortage of machines.)

So I got curious as to what my insurance (BCBS) would need if I were to need to submit a "Subscriber Claim" that wasn't billed to the insurer directly. Basically there is a 'Subscriber Claim Form' that is filled out with the subscribers/patient information and along with that also needs to be submitted is an itemized bill from the business that provided the procedure or service. The 'Subscriber Claim Form' does not have a block to enter the HCPCS code, but would be required on the itemized bill. It would be my understanding that the facilities that repaired your CPAP should have included the coding and other pertinent information relevant to the repair on the bill you received. Again this is BCBS and your insurer may do things a bit differently, but likely similar.

This is a screenshot of the example bill a provider should be giving you. It may not look exactly like this, but close. Did you insurer provide any forms and instruction as to what is needed? I downloaded these forms from my BCBS website.

Grumpy48 wrote: ↑

Mon Mar 06, 2023 4:08 pm

Again this is BCBS and your insurer may do things a bit differently, but likely similar.

BCBS is an association of 34 independent and locally operated companies. They all vary in their policies. Within one local BCBS company, there are multiple policies that vary in their terms. Each company even has more than one policy for Medicare patients. So saying "this is BCBS" does not convey anything beyond basic information.

ChicagoGranny wrote: ↑

Mon Mar 06, 2023 2:40 pm

Fourbtgait wrote: ↑

Sun Mar 05, 2023 10:09 pm

So what is squirrelly about that?

Repairing a five-year-old machine is squirrely.

If your insurance company figures out how old it is, you are unlikely to get reimbursed. (Although, some insurance companies have temporarily liberalized their practices due to the market shortage of machines.)

The machine broke under the 5 year limit.
Insurance would not pay for a new machine until 5 years is up.
Repairing it was low cost, whether I get reimbursed or not.
Now I have a spare.
Enjoy your life.

Fourbtgait wrote: ↑

Mon Mar 06, 2023 6:33 pm

Repairing it was low cost, whether I get reimbursed or not.
Now I have a spare.

Now you are making sense.