We had previously billed the wrong code for the initial RT evaluation and payment was denied. Should we re-bill the correct code or should we submit the corrected code through the appeal process?
A. The original bill should not change on appeal. Future bills should only include skilled services as defined by the CORF manual and the pulmonary rehabilitation policy. The documentation for the evaluation should support the need for the skilled service and be medical necessary. Q. Can HCPCS code 78195, lymphatics and lymph node imaging, only be billed with HCPCS codes 38500, 38525, 38530, and 38792 which are specific to biopsy of the breast and injection procedure for identification of sentinel nodes? A. No. The policy on Sentinel Lymph Node Biopsy in Breast Carcinoma is written specifically to address issues of breast carcinoma. The use of HCPCS code 78195 is not limited only to this policy, but is incorporated as a secondary part of the sentinel node identification procedure. Documentation of the ICD-9 codes and any other documentation in the medical records to support the medical necessity of the procedures should support billing of 78195 in conjunction with any of the other 4 co
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