MEDICAL BILLING INFORMATION NEWSLETTER (Note:01)            3/26/93

#1. Use of new Initial Observation Services: Medicare coverage
outlined on page 5 of December Special HCPCS UPDATE, for general
use see pages 23-25 of 1993 AMA CPT book. 

#2. Critical care (99291-99292) billing: only one physician may
bill even if more than one physician is providing care. No limit on number
of critical care services billed per day (except for Medicaid) or per 
hospital stay,however 2.5 hours usually will require documentation.
If total time is less than 30 minutes, use the appropriate E&M code.

#3. Revised Global Fee Period:
11040 10-00, 11041 10-00, 11042 10-00, 11043 90-10, 11044 90-10
11900 10-00, 11901 10-00, 21550 10-00, 20660 90-00, 30901 10-00
30903 10-00, 30905 10-00, 30906 10-00, 31600 90-00, 31601 90-00
32002 10-00, 32005 10-00, 32020 10-00, 32700 90-00, 32705 90-00
36010   - 0, 43460 90-00, 43750 90-10, 47000 10-00, 54220 10-00 
59840 90-10, 59841 90-10, 61107 90-00, 61210 90-00, 64600 90-10
64605 90-10, 64610 10-00, 65205 10-00, 65210 10-00, 65220 10-00
65222 10-00, 69610 90-10

#4. Modifier 22: to identify an increment of work that is
infrequently encountered with a particular procedure and is not
identified by another CPT code. Use only with primary procedures,can be
used with major and minor surgery procedures.

#5. MSP: Provider is not limited in charge amount to the primary
payor,however amount collected from the patient cannot exceed the 
allowable fee or charge limit amount.

#6. Watch for:
(1)information regarding "Referrals" as they pertain to E&M/Consult codes.
(2)State of Fl 1993,mandated assignment in "emergency medical condition" 
 & when "primary physician accepts assignment.
(3)policy to be established for Q5&Q6 "covering physician" modifiers.

PC Management specializes in medical billing information. Telephone
support and special project services available on an hourly, monthly or
yearly basis. Now is the time to check out our "Medicare Superbill Edit",
a complete profile of the 1993 rules and regs per the procedure codes 
billed by your office.  This handy guide is great as a quick 
reference for calculating charge limits (multiple surgery type )or for
"review" documentation. The Superbill Edit can be used as a Policy and
Procedure Guideline, or as a training manual.

The Superbill Edit is available in notebook ("hardcopy") or in appropriate
diskette format for your computer. [pec/PCM]

CALL PC MANAGEMENT AND ASK ABOUT THE SERVICES AVAILABLE TO ASSIST YOUR
BILLING STAFF.