There’s been 3 recent MSP changes that will affect the way you bill “fee-for-service” (FFS) items.
Please note the following changes are effective immediately:
#1. Billing Procedures and 1800 visit codes with the same ICD-9 code
You can now bill procedures and 1800 visit codes with the same ICD-9 code or the generic 78X ICD-9 diagnostic codes. Just make sure you have the appropriate documentation to meet the level fee item.
If you’re billing the 12,13,15,16,17,18200 Visit – out of office or the 12,13,15,16,17,18201 Complete examination – out of office, fee items must continue to use non-related ICD-9 diagnostic fees in order to be paid for both visit and procedures.
#2. 01850, 01851, 01860, 01861, 01862 can now be billed on All Patients
01850 (clavicle fracture) and 01851 (fibula fracture) have been revised and no longer include “adult only” and “operation only”. This means that they can now be billed on all patients.
Note: If you’re using 01850 or 01851 within an emergency department, they must include the submission code “E” but cannot be billed with a visit fee. This means they replace the 1800 visit codes or fee items “12,13,15,16,17,18200 Visit – out of office” or the “12,13,15,16,17,18201 Complete examination – out of office.”
In order to bill these items, documentation must include “the history including mechanism, focused physical exam and a discussion with patient (or guardian) about temporary immobilization for comfort and arranging orthopaedic follow up as required.”
In addition, 01860 (Temporo-mandibular joint dislocation-closed reduction), 01861 (patella-closed reduction), and 01862 (Toe – closed reduction) have also been reworded and no longer include “operation only.” If you’re using them within an emergency department, they must include the submission code “E” and can be billed with 1800 visit codes.
#3. Changes to Casting fees (51016, 51017, 51019, 51020, and 51021)
Casting fees have been edited to eliminate “plaster-moulded,” and now include all mouldable splints. The Casting Fee Code now reads as:
“Formation and application of moulded casts or splints may be charged in full in addition to procedure and visit fees with the following exceptions:
- Formation and application of a cast or splint at the time of the initial orthopedic procedure charged is included in the procedure
- In the minority of cases when application of a cast or splint is the sole purpose of a visit, a visit fee may not be charged
Fees for formation and application of moulded casts or splints are payable only when performed by the medical practitioner. Multiple casts (eg. bilateral leg casts) are paid at 100%.”
Coming Soon: New Resuscitation 18911 code
Although the final wording for this code hasn’t been finalized yet, it will take the place of 00081 and 00082 fee items. The new code will simplify billing for life, limb or sight saving resuscitations in the emergency department.
If you have any questions regarding the new changes, please don’t hesitate to contact our billing experts here.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
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