Reimbursement 101 2011 - Cardinal Health

More documents

Recommendations

Info

Coding - Hospital Revenue Codes • 034X Nuclear Medicine Subcategory Standard Abbreviations 0 - General Classification NUCLEAR MEDICINE or (NUC MED) 1 – Diagnostic Procedures NUC MED/DX 2 – Therapeutic Procedures NUC MED/RX 3 – Diagnostic Radiopharmaceuticals NUC MED/DX RADIOPHARM 4 – Therapeutic Radiopharmaceuticals p NUC MED/RX RADIOPHARM 9 – Other NUC MED/OTHER • 040X Other Imaging Services 4 - Positron Emission Tomography PET Scan © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Coding > Claim Forms • Hospitals use claim form 1450 (UB-04); reimbursement for hospital services • Clinic/physician office imaging imaging, and physician professional services use claim form 1500; reimbursement for: 45 • Technical component only (covers equipment, supplies, office expense, non-physician staff) CPT code with modifier TC • Professional component only (covers physician interpretation of scan) CPT code with modifier 26 • Global – Technical plus professional component combined; no modifier © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Page 1 and 2: Nuclear Medicine Reimbursement 101
Page 5 and 6: Reimbursement Terminology 5 • HCP
Page 7 and 8: Reimbursement Terminology 7 • HOP
Page 9 and 10: NM Reimbursement 101 > A/B MACs 9
Page 11 and 12: A/B Medicare Administrative Contrac
Page 13 and 14: NM Reimbursement 101 > A/B MACs 13
Page 15 and 16: NM Reimbursement 101 15 © Copyrigh
Page 17 and 18: Reimbursement - Hospital Outpatient
Page 19 and 20: Reimbursement - RP in Clinic Settin
Page 21 and 22: Reimbursement - Private Payers 21
Page 23 and 24: Coverage • Most important issue i
Page 25 and 26: Coverage - Private Payers • Incre
Page 27 and 28: Coverage - Medicare A service or pr
Page 29 and 30: Coverage - Medicare 29 • In gener
Page 31 and 32: CMS Coverage with Evidence Developm
Page 33 and 34: PET Coverage > Medicare Medicare Na
Page 37 and 38: Coding 37 • ICD-9-CM - Internal C
Page 39 and 40: Coding 39 CPT/HCPCS codes • The n
Page 41 and 42: Coding Modifiers • Two character
Page 43: Coding - Hospital Revenue Codes •
Page 47 and 48: Coding > Claim Form 1450 (Hospital)
Page 53 and 54: Coding > Claim Form 1500 Clinic/Phy
Page 55 and 56: NM Reimbursement 101 - References 5
Page 57 and 58: NM Reimbursement 101 - References h

Reimbursement 101 2011 - Cardinal Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?