tci Part B Insider - 2013 Issue 1

Reader Question: Special Codes Will Alert You of New Discounts

Question: I read your article about Medicare’s new policy of applying the Multiple Procedure Payment Reduction (MPPR) to the technical component (TC) of diagnostic cardiovascular and ophthalmology procedures for services done on the same day with the same patient. Our clinic performs both of these types of service, and we are wondering how we’ll know which claims our contractor reduced? Answer: You’ll know which technical components were hit with the discounts when you receive a Claim Adjustment Reason Code of 59 (Processed based on multiple or concurrent procedure rules [For example, multiple surgery or diagnostic imaging...

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