Frequently Asked Questions
All FAQs are current as of the date noted next to the question.
| 1. | Can I change a diagnosis code on a previously submitted claim? |
Yes, as long as you are not requesting a review.
Rev. (06/20/06) |
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| 2. | For the following situation, what does WPS Medicare require for the primary linked diagnosis - A) the screening diagnosis or B) the diagnosis for the condition/findings?: During a colorectal cancer screening, a lesion or grown is detected which results in a biopsy or removal of the growth. |
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You must bill the appropriate diagnostic procedure with biopsy or removal. You must report diagnosis codes that support medical necessity of a diagnostic colonoscopy. These codes are found in Local Coverage Determination (LCD) GI-006. You may still report the screening V-code as one of the diagnoses; however, diagnoses that support medical necessity per Local Coverage Determination (LCD) GI-006 must be reported. Medicare will consider all diagnoses codes on the claim.
You can access these policies on the WPS Medicare Website at the locations below. GI-006 
GI-008
Posted (06/04/07) |
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| 3. | For Medicare billing purposes, is it mandatory that providers use only professionally certified coders? |
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No, it is not necessary that you employ professional coders to bill Medicare for your services. However, it is important to understand that all providers who submit Medicare claims are responsible for accurate billing. It is considered a mistake if you make an error in "good faith" or without the intent of providing false information. If a mistake occurs, Medicare expects that providers return payments made erroneously. WPS Medicare does not assess penalties when you report a billing error.
To avoid billing mistakes, providers should use educational resources that are available on our Website. These resources include on-line tutorials, Medicare e-News, articles, and seminars. You can find provider education resources by accessing the Website . Please keep in mind that coding professionals are your best source of information regarding coding questions. Our Medicare Policy, Medical Review, Provider Outreach, and Customer Service staff members are not professional coders. In certain situations, we can help providers with coding questions as they relate to a specific Medicare policy or a specific finalized claim. However, WPS Medicare staff members cannot provide any coding advice. Posted (07/16/07) |
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Page Last Updated: Tuesday, 04-Dec-2007 13:19:00 CST
