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Attention Independent Clinical Labs Submitting Procedure Code 83036

Mon, 2013-04-22 11:48

A service-specific probe review was completed for CPT code 83036 glycated hemoglobin (A1C) for specialty 69 (Independent Clinical Lab). Major issues identified were documentation not received and services not medically reasonable or necessary. WPS Medicare must receive the documentation requested within 45 days or we will deny the service. It is important providers submit all requested documentation in a timely manner. It is not reasonable and necessary to perform procedure code 83036 more often than once every three months.

Widespread Service-Specific Probe Results for Hemoglobin A1C, CPT code 83036

Thu, 2013-02-28 11:28

Medical Review has completed an article for the Widespread Service-Specific Probe for Hemoglobin A1C, CPT code 83036. Records were reviewed to determine whether the procedure code billed met all documentation requirements for the services billed. Services for CPT code 83036 were denied if the documentation did not support the service billed as defined in the NCD 190.21 - Glycated Hemoglobin/Glycated Protein.

The major issues identified that led to the denial of 70.00% of these services are as follows:

Coding Modifiers Table Update

Tue, 2012-11-27 09:41

When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service can be identified by adding modifier 92 to the usual laboratory procedure code. KMAP will only consider reimbursement for services with modifier 92 if billed with codes 86701, 86702, 86703, and 87389.

Implementation of the Award for the J5 A/B MAC Reprocurement Including a New Workload Number for the Remaining WPS Legacy Workload

Thu, 2012-09-27 10:38

CMS is required to compete the A/B MAC workloads at least once every 5 years. It recently did so for the Jurisdiction 5 A/B MAC and awarded this workload to WPS, the incumbent contractor. CMS has determined that it will not need to change the current Jurisdiction 5 workload numbers when this new contract is implemented. This applies to the Part B states of: Iowa, Kansas, Missouri and Nebraska Providers as of Sept. 10, 2012.

Laboratory Providers HCPCS 2012

Sun, 2012-01-15 16:00

Effective with dates of service on and after January 1, 2012, Molecular Pathology Codes 81200 through 81408 will not be covered. At this time, KMAP has elected to follow the CMS coverage determination for this range of codes. These services will need to continue to be billed using the already established stacked procedure code method.

Laboratory Providers HCPCS 2012

Sun, 2012-01-15 16:00

Effective with dates of service on and after January 1, 2012, Molecular Pathology Codes 81200 through 81408 will not be covered. At this time, KMAP has elected to follow the CMS coverage determination for this range of codes. These services will need to continue to be billed using the already established stacked procedure code method.

Revised Clinical Laboratory Fee Schedule and ZIP Code File to Include New Kansas Payment Locality Structure

Thu, 2010-03-04 15:12

This article is based on CR 6787 which instructs the Medicare contractors to incorporate an additional Kansas payment locality in the Clinical Laboratory Fee Schedule (CLFS) into their system to ensure correct pricing for certain laboratory claims submitted with a “90” modifier for services performed in the Kansas payment localities.

CERT Errors Regarding Complete Blood Count (CBC) Services

Wed, 2010-01-06 15:26

WPS Medicare has noted an increase in the number of Comprehensive Error Rate Testing (CERT) errors related to CPT codes 85025 and 85027. Based on review of documentation, either the test administered or the physician order did not support the service billed to Medicare.

These codes are defined in CPT® 2009 as:

  • 85025 - Complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count.
  • 85027 - Complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)

Timely Filing of Claims - Important Notice About Claim Denials

Wed, 2010-01-06 15:26

Recently, WPS Medicare began seeing a dramatic increase in the number of providers experiencing claim denials when the provider submits claims past the timely filing limit for submitting claims. Although WPS Medicare recognizes that many providers must submit claims after Medicare's timely filing limit due to circumstances beyond their control, WPS Medicare must deny any claim submitted after the time limit for filing the claim expires.

Use of Initials in Medical Documentation

Wed, 2009-12-02 10:33

WPS Medicare – Carrier/FI for Iowa, Illinois, Kansas, Minnesota, Michigan, Missouri, Nebraska and Wisconsin.

Recently, WPS Medicare received the following question and statement, "Do initials satisfy Medicare's documentation requirements? Our physician feels that providing a full "signature" to each medical record is not efficient and is time consuming."

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