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.
Do we give a MOON letter to a patient who was originally assigned to inpatient status, but then reassigned to observation services when the utilization review committee determined that he or she did not meet inpatient criteria. In this instance, condition code 44 was used and the patient’s status was changed to observation. If we are required to deliver the MOON form in this situation, should it be given to the patient at the same time as the patient is given information on condition code 44?
Q: We are confused on the reporting of HCPCS code C9399 (unclassified drugs or biologicals) for new diagnostic radiopharmaceuticals and contrast agents that are approved by the FDA but don’t yet have a HCPCS code. CMS guidance states that this HCPCS code should be used until a specific HCPCS code for the item has been assigned, but we have one that is going on two years and there is not a new HCPCS code assigned yet. When we ask about it, the answers have varied.
