Jonathan,
Only valid HCPCS modifiers are allowed to be sent in the 837 in association with a
HCPCS code. That would eliminate your duplicates, but now it sounds like that creates
another challenge for you, what valid HCPCS modifiers to replace the proprietary
madifiers with.
Stuart
-----Original Message-----
From: Jonathan Fox [mailto:[EMAIL PROTECTED]]
Sent: Tue 3/19/2002 4:14 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: 837P - Ambulance Modifiers
Stuart,
Thanks for replying. The only problem I have with your response is that there
are codes that already exist for those combinations.
For example:
EM - Emergency reserve supply (for ESRD benefit only)
EP - Service provided as part of medicaid early periodic screening diagnosis
and treatment (EPSDT) program.
GE - This service has been performed by a resident without the presence of
a teaching physician under the primary care exception.
GG - Performance and payment of a screening mammogram and diagnostic
mammogram on same day
GH - Diagnostic mammogram converted from screening mammogram on
same day.
GJ - OPT OUT physician or practitioner emergency or urgent service.
GN - Service delivered personally by a speech-language pathologist or
under an outpatient speech-language pathology plan of care.
GP - Service delivered personally by a physical therapist or under an
outpatient physical therapy plan of care.
How do we accommodate these "duplicate" codes?
Thanks.
Jon
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>>> [EMAIL PROTECTED] 03/19/02 01:55PM >>>
Jon,
Your first example is the correct way to send modifiers to HCPCS codes.
SV1*HC:A0090:HR*540*UN*1***1**N~
There is also an example with the SV1 segment in the 837P (X098)
Implementation Guide with a modifier on page 400.
Hope this helps,
Stuart Beaton
Vice President
Washington Publishing Company
Co-chair X12N/TG2/WG1 (Eligibility)
-----Original Message-----
From: Jonathan Fox [mailto:[EMAIL PROTECTED]]
Sent: Tue 3/19/2002 9:00 AM
To: [EMAIL PROTECTED]
Cc:
Subject: 837P - Ambulance Modifiers
I am part of the wnyhealthenet Consortium, LLC and we need
clarification regarding the work that was done by Sarah Lanthier on ambulance HCPCS
codes and modifiers. I looked in the free stuff section of Claredi's website and did
not find an ambulance claim WITH a modifier. So I pose this question to you.
Our question is related to how the codes and modifiers should be
represented in the 837P.
Please indicate which example is correct:
1.) SV1*HC:A0090:HR*540*UN*1***1**N~
2.) SV1*HC:A0090:H :R *540*UN*1***1**N~
3.) None of the above.
This is not intended to be a trick question.
Please advise.
Thanks,
Jon Fox
Co-Chair, wnyhealthenet Consortium, LLC
Transactions Workgroup
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the designated addressee, you are hereby notified that any disclosure, copying, or
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the e-mail and its attachments from your computer. Thank you for your attention.
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