CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Billing and Reimbursement Guideline: Venous Procedures with Surgery

Guideline governing coding, documentation and reimbursement when venous procedures are billed with colonoscopic, endoscopic, or sigmoidoscopy surgical procedures for Neighborhood Health Plan of Rhode Island providers. Applies to CMS-1500 and UB-92 claim submissions and is informational rather than a guarantee of payment.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyBilling and Reimbursement Guideline: Venous Procedures with Surgery

Policy CodePolicy N/A

Change TypeFormat change, minor edits

Effective DateSep 1, 2010

Next Review DateN/A

Key ActionDo not bill venous procedures separately when performed with colonoscopic, endoscopic, or sigmoidoscopy procedures; they are considered components of the primary service.

SourceLink

POLICY UPDATE CHANGES

Format change, minor edits

3procedure types disallowed for separate payment

CMS-1500/UB-92claim submission forms

2010-09-01original publication

2013-09-01revision date

When Venous Procedures Are Not Separately Payable

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyBilling and Reimbursement Guideline: Venous Procedures with Surgery

Policy CodePolicy N/A

Change TypeFormat change, minor edits

Effective DateSep 1, 2010

Next Review DateN/A

Key ActionDo not bill venous procedures separately when performed with colonoscopic, endoscopic, or sigmoidoscopy procedures; they are considered components of the primary service.

SourceLink

On This Page

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Non-separately payable combinations

When venous procedures are billed with the following procedures, separate payment is not allowed because they are considered components or incidental:

ALL of the following

ONE of
- Colonoscopic procedures billed with venous procedures (venous procedures are considered components of or incidental to the colonoscopic service).
- Endoscopic procedures billed with venous procedures (venous procedures are considered a component of or incidental to the endoscopic service).
- Sigmoidoscopy procedures billed with venous procedures (venous procedures are considered components of or incidental to the sigmoidoscopy service).

This guideline applies to both CMS-1500 and UB-92 claim submissions.

Billing and Payment Restrictions — Provider Impact

Billing Rule

Do not bill venous procedures separately when performed with colonoscopic/endoscopic/sigmoidoscopy services

Separate payment is not allowed for venous procedures when they are billed with colonoscopic, endoscopic, or sigmoidoscopy procedures because the venous work is considered a component of or incidental to the primary service. Providers should not bill these venous procedures as separately payable when submitting claims on CMS-1500 or UB-92 forms and must align billing to reflect the primary endoscopic procedure.

Do not submit separate charges for venous procedures when billed with colonoscopic, endoscopic, or sigmoidoscopy procedures.
Apply this guideline to claims submitted on CMS-1500 and UB-92 forms.
Ensure documentation supports that the venous procedure was performed as part of the primary endoscopic service, but do not expect separate reimbursement.

OpenPayer

Billing and Reimbursement Guideline: Venous Procedures with Surgery

When Venous Procedures Are Not Separately Payable

Applicable Codes and Claim Forms

Billing and Payment Restrictions — Provider Impact

Definitions and Scope