When providing Pneumatic Compression Devices (PCDs) to patients, be sure the
patient meets all Medicare coverage criteria. Recovery Auditors perform complex reviews on claims for
these devices to determine if the PCD is reasonable and necessary for the patient’s condition based on the
documentation in the medical record. Claims that do not meet the indications of coverage and/or medical
necessity will be denied. Affected codes are E0650, E0651, E0652, E0656, E0657, E0667, E0668, E0669
and E0670.
Hospital emergency department services are not payable for the same calendar
date as critical care services when billed for the same beneficiary, on the same date of service and by the
same service provider (based on Tax ID and Provider Specialty Code). Affected codes: 99281, 99282,
99283, 99284, 99285.
Aetna has agreed to pay $1,000,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA)
“I have a patient who will undergo a Cartiva implant procedure for hallux limitus/rigidus at the 1st metatarsophalangeal joint. He also has lateral deviation of his hallux on the same foot and an Akin osteotomy will be performed to address this deformity. Should the Akin osteotomy be billed as a separate procedure or is that considered unbundling?”
