Ask the Expert

Q: What are the requirements for using condition code 44?

Should physicians write an order for a specific postacute care provider, such as a home health agency or skilled nursing facility?

Q: We have started receiving rejections for claims with HCPCS code C1842 (retinal prosthesis, includes all internal and external components). We provide the service with the retinal implant and are confused why it's getting rejected.

If my hospital submits an appeal to a payer and the payer upholds the denial, what next steps can we consider?

Should a choice be given for all types of postacute care providers?

Our experts answer questions about hitting MUEs on injections and infusions, setting multiple prices for the same CPT codes, payment rates for cancer centers, and more. 

Q: We have received rejections for claims reporting the application of skin substitutes, with the edit stating there is a mismatch of the procedure and the skin substitute. We are using the table that was published in the 2017 OPPS final rule. Has something changed?

Should hospitals refer patients to postacute care providers with which they have a financial relationship?

Q: We are having an internal disagreement regarding HCPCS code G0498. Our clinical department believes that this code is to be reported in addition to the chemotherapy administration charge. Our coders and chargemaster coordinator disagree and believe it is an all-inclusive code. Who’s right?

What role do case managers play in HINN 12 delivery?