tci Medicare Compliance & Reimbursement - 2008 Issue 29

Reader Question: Don't Let Billers Add Services To Claims Without Permission

Only report what shows on the encounter superbill. Question: Our office uses an outside biller. In reviewing some of the EOBs, I've found instances when the biller is adding services that the physician hasn't marked on the superbills. For example, a patient came in for a follow-up appointment (99213) and she received an injection of Toradol (J1885). The biller added 90772 to the claim as well. Is it OK for her to do this? Answer: Stick to the adage, "If it's not in the documentation, you cannot bill it." When billing, you should never add codes for services...

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