Echocardiography Procedures Will No Longer Require Precertification Effective February 1, 2016
Effective February 1, 2016, the MO HealthNet Division (MHD) will no longer require precertification for the following echocardiography procedure codes:
Reimbursements for Circumcisions
As announced in the June 12, 2014, Volume 36, No. 31, Physician Bulletin, effective June 15, 2014, MO HealthNet will pay for elective circumcisions for all newborn infants less than 28 days old using Current Procedural Terminology (CPT) codes 54150 and 54160.
Reconstructive Breast Surgery
Reconstructive breast surgery is considered a MO HealthNet covered service, if necessary to restore symmetry as recommended by the oncologist or primary care physician for the patient incident to mastectomy, as well as other documented medical necessity deemed appropriate via MO HealthNet physician consultant review.
Billing for Multiple Surgical Procedures
MO HealthNet Division (MHD) receives inquires regarding MHD policy for claim denials concerning multiple surgical procedures on the same patient on the same date of service. Please refer to Section 13.33.F of the Physician Provider Manual for additional information on billing for multiple surgical procedures.
Hospital Medical Record Documentation
As stated in the Introduction to the International Classification of Diseases Ninth Edition (ICD-9) Official Guidelines for Coding and Reporting, a joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses.
Temporary Assistance for Pregnant Women Benefits and Limitations for Hospital
The Temporary Assistance for Pregnant Women (TEMP) program, ME codes 58 and 59, is fee-for-service only and is limited to ambulatory prenatal care.
A pregnancy or prenatal diagnosis code is required on the claim form in one of the diagnosis fields. If the TEMP participant is provided illness care, the illness diagnosis code must appear as the primary diagnosis code. However, a pregnancy or prenatal diagnosis code must also appear on the claim form.