Effective for dates of service on or after January 1, 2009 for allowed ASC claims, if modifier = TC, contractors must ensure that either:
• ordering physician name and NPI or
• referring physician name and NPI are present on electronic or paper claims.
If this information is missing, contractors shall return as unprocessable and use Claim Adjustment Reason Code 16 - Claim/service lacks information which is needed for adjudication. Also use the appropriate remittance advice remark codes:
N264 - Missing/incomplete/invalid ordering provider name
N265 - Missing/incomplete/invalid ordering provider primary identifier
N285 - Missing/incomplete/invalid referring provider name
N286 - Missing/incomplete/invalid referring provider primary identifier
Ambulatory surgical center billing code guidelines and how to get payment from insurance. ASC denial, CPT CODES , Authorization and referral Guide. Multiple procedure, Surgical procedure tips. What to get the correct reimbursement in ASC billing setup. SNF billing Guide, tips to use correct CPT AND POS.
Monday, September 5, 2016
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