Project Overview
______ is defined as all ESIs or spinal procedures performed on a single day.
What is a session?
The modifier that signifies bilateral procedure: Unless otherwise identified in the listing is what?
What is Modifier 50?
The physician wrote an order for an ESI and it was included within the documentation submitted for review; however, the order is not signed. I must send for a signature attestation, true or false?
What is False?
The documentation supports the services as reasonable and Necessary.
What is Medical Necessity?
_____ is defined as the placement of a needle into the epidural space.
What is Injection?
In OnBase, this indicates the provider is financially liable.
What is Contractual obligation(CO)?
An ______ must contain Beneficiary’s Name, Description of the service, description should describe the service/surgery to be performed, Physician’s Signature, Must be signed by the performing physician/NPP, Date
What is the Physician order?
While reviewing a claim for a provider in jurisdiction JF using CPT 64484 and billing 4 units. What denial code would you use for this scenario?
What is GBC04?
An ____is performed by placing the needle directly in from the back of the spine between the lamina of two adjacent vertebra.
What is interlaminar injection?
In OnBase, this indicates the beneficiary is financially liable.
What is Patient Responsibility(PR)?
__________ vary between LCDs. Please ensure to review the applicable LCD for the jurisdiction on your claim Date of Service (DOS). Requirements are located throughout the LCD. Take note of should or must verbiage to determine a requirement.
What is Documentation requirements?
When a diagnostic spinal nerve block is performed, post-block assessment of percentage pain relief must be documented. What are at least 4 LCD's with this requirement?
What is LCD L34807, L34980, L35148, L35937, L36521, L36920
Minimum documentation requirements of diagnostic testing are found in the applicable________?
What is LCD/LCA?
This is a CPT code used as an "add-on" code, to indicate injections were performed in additional levels.
What is CPT 64484?
There may be a claim where the SMRC will request documentation from the provider that ordered the service versus the provider that billed the service.
What is Third Party ADRs?
Which LCD's contain the following wording? All elective (non-emergent) ESIs should be done with image-guidance.
What is LCD L34807 and L35148?
The _________ procedure involves the injection of a solution containing corticosteroids and anesthetic into the epidural space, although saline may be included at times.
What is transforaminal approach?
Which modifier is Waiver of Liability Statement issued as Required by Payer Policy. Used to report that a required Advance Beneficiary Notice of Noncoverage (ABN) was issued for a service and is on file. A copy of the ABN does not have to be submitted but must be made available upon request.
What is GA modifier?
According to each LCD there is criteria that includes should and shall language. A should is a recommendation and a MUST is a requirement. If/where this appears as “SHOULD” language is used in the LCD’s, reviewers will not issue denials based on “should” language/requirements. The reviewer will submit a ____ if there is a question regarding a should statement in the LCD/LCA.
What is a consult?
Local anesthesia or minimal conscious sedation may be appropriate. Use of moderate sedation and Monitored Anesthesia Care (MAC) is usually unnecessary. Documentation must clearly establish the need for such sedation in the specific patient. Which LCD's contain this information?
What is LCD L34980, L34982, L35937, L36521?