- D. When an infusion is ordered by the provider, there should be a signed order from the provider. If a prior authorization is needed, it should be obtained, with the number of infusions, along with the start and end dates of the authorization. Also, a prior authorization does not guarantee reimbursement; an insurance verification should be done to ensure all the patient’s benefits. For example, the practice staff should verify the patient’s financial responsibility.
- D. Medicare will only reimburse for a DXA every 23 months for each individual patient. Thus, even if the practice did not perform the scan and the patient is unsure of the last time a scan was performed, the current practice will take the risk of not getting reimbursed. The only way to avoid disruption is to have the patient sign an ABN stating the patient could be liable for the expense if Medicare does not reimburse for this service.
- B. If a patient has been authorized to have a series of joint injections and they have no other complaints, an E/M visit cannot be scheduled along with the injection.
- C. Although other infusions were reimbursed, this does not guarantee the patient is still eligible for additional procedures, or it is still covered by the insurance carrier.
For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA at mtillman@rheumatology.org or 404-633-3777 x820.