Administrative Simplification Coding Recommendations

The AUC has identified a number of questions and requests for clarification regarding the claim type to be submitted under a variety of scenarios. Below is a list of scenarios and the type of claim to be submitted for the each of the scenarios listed. (The following is provided for general information only. For additional information, see resources such as …)

Outpatient professional services provided by Critical Access Hospitals (CAH), Method II billing:

• Outpatient professional services provided by CAH electing Method II billing should be reported on the professional claim type (i.e. 837P).

Rural Health Clinics/Federal Qualified Health Centers:

• Report on the claim type with procedure codes appropriate to the services provided, e.g., physician/clinic services on the 837P, dental services on the 837D, pharmacy on NCPDP.

Ambulatory Surgical Centers:

• Per trading partner agreement, either the 837P or the 837I claim type is allowed. Check with payer to determine the preferred billing method.

Indian Health Services:

• Report on the claim type with procedure codes appropriate to the services provided, e.g., physician/clinic services on the 837P, dental services on the 837D, pharmacy on NCPDP.

The AUC has identified a number of questions and requests for clarification regarding coding for modifier 50 and bilateral procedures under a variety of scenarios. Below is a list of modifier and bilateral procedure scenarios with coding information for each of the scenarios listed. (The following is provided for general information only. For additional information, see resources such as …)

Modifier 50 – Physician services:

• Modifier 50 should only be used on surgical services that can be performed bilaterally and are not already defined as a bilateral service. Bilateral services are to be reported with the 50 modifier on one line with one unit.

Modifier 50 -- Ambulatory Surgical Centers:

• Modifier 50 should be used on surgical services that can be performed bilaterally and are not already defined as a bilateral service. When appropriate, report the service appended with the 50 modifier on one line with one unit.

Bilateral Radiology -- radiology services and other diagnostic procedures:

• Bilateral radiology services are reported as either:
  1. one line with a 50 modifier and one unit, or
  2. two separate lines, one with RT modifier and one with LT modifier.

Bilateral Radiology -- physician services:

• Bilateral radiology services are reported as either:
  1. one line with a 50 modifier and one unit, or
  2. two separate lines, one with RT modifier and one with LT modifier.

Bilateral Radiology -- Ambulatory Surgical Centers:

• Professional bilateral radiology services are reported as two separate lines, one with RT modifier and one with LT modifier.

The Minnesota Department of Human Services (DHS) is the state’s single largest health care purchaser and administers a broad range of publicly funded Minnesota Health Care Programs (MHCP) and services. DHS provides resources and information regarding MHCP and related services on its Provider Manual webpages and other webpages.

The AUC Medical Code TAG (MCT) has identified several DHS programs and services as of particular interest to medical coders because they were perhaps recently implemented or modified, are complex, less well known, and for other similar reasons.

The MCT has created a list of “shortcuts” (links) to the DHS provider manual or other resources below with more information regarding topics it has identified as of possible interest. The MCT will periodically review and update the list below. Please see the DHS Provider Manual for medical coding and other information on additional MHCP topics of interest.

• Personal Care Assistance (PCA) Services
• Homemaker services (as part of Elderly Waiver (EW) and Alternative Care (AC) Program)
• Interpreter Services (part of Access Services)
• Collaborative psychiatric consultation (Psychiatric Consultations to Primary Care Providers)
• In-reach Community-Based Coordination (Hospital In-reach Service Coordination (IRSC))
• Non-emergent, scheduled transport (Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services)
• Non-emergent, scheduled transport (as part of Day Training and Habilitation (DT&H) Day Services)
• Community Paramedic Services
• Doula Services (Per MS §256B.0625, Subd. 28B Doula Services)
• Behavioral Health Home
• Health Care Homes
• Vaccines acquired through the Minnesota Vaccines For Children (MnVFC) program (Immunizations & Vaccinations)
• Child and Teen Checkups (C&TC)
• Family caregiver coaching and counseling with assessment – AC, ECS and EW
• Family caregiver services – AC, ECS and EW
• Community Emergency Medical Technician (CEMT) Services