73502 + 72170

edited May 2017 in Orthopedics
Is it appropriate to report both 73502 and 72170 on same claim? I’m reading conflicting information and would appreciate some clarification. Thanks.
Keith

From: Ruby Woodward [mailto:rubywdwrd@gmail.com]
Sent: Thursday, April 28, 2016 7:41 AM
To: Multiple Recipients of Ortho-L
Subject: Re: [ortho-l] Fracture Care

You don't know they aren't going to return. If you provided the treatment with the plan to follow up at the time billed you followed the "rules". From a practice management standpoint you could do a follow up call to the patient to check on their status and remind they were to return. And document it.

Ruby Woodward
Sent from my iPhone

On Apr 27, 2016, at 1:05 PM, Mcdonald, Keith wrote:
How do you handle a patient that you provide a global fracture care (23500) and the patient does not show up for post-op visits? Can you still report global code?
Thanks..

From: Marla Gould [mailto:mgould329@gmail.com]
Sent: Wednesday, April 27, 2016 12:30 PM
To: Multiple Recipients of Ortho-L
Subject: Re: [ortho-l] Billing family members

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c16.pdf


page three...excluded from billing

10 - General Exclusions from Coverage (Rev. 198, Issued: 11-06-14, Effective: 01-01-15, Implementation: 01-05-15) No payment can be made under either the hospital insurance or supplementary medical insurance program for certain items and services, when the following conditions exist: - Not reasonable and necessary (§20); - No legal obligation to pay for or provide (§40); - Paid for by a governmental entity (§50); - Not provided within United States (§60); - Resulting from war (§70); - Personal comfort (§80); - Routine services and appliances (§90); - Custodial care (§110); - Cosmetic surgery (§120); - Charges by immediate relatives or members of household (§130); - Dental services (§140); - Paid or expected to be paid under workers’ compensation (§150); - Non-physician services provided to a hospital inpatient that were not provided directly or arranged for by the hospital (§170); - Services Related to and Required as a Result of Services Which are not Covered Under Medicare (§180); - Excluded foot care services and supportive devices for feet (§30); or, - Excluded investigational devices (See Chapter 14).


Sincerely,
Marla


On Wed, Apr 27, 2016 at 12:21 PM, Pam Epperson wrote:
Help me out list serve, as I have lost the email and need the documentation.

I have a doc that thinks he can bill his family members - especially when they are Medicare beneficiaries.

I know that it is unethical and I am telling him the same regardless the carrier.

Comments

  • edited May 2017
    Uh, No.If you did a lateral left hip with an AP pelvis that equals 2 views CPT code NO separate pelvis code 72170.

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