First Coast Service Options Inc. (FCSO) has been made aware of an issue regarding providers receiving denials when billing CPT code 84295 (Sodium; serum, plasma or whole blood) and ICD-9-CM code 585.6 (End-stage renal disease) for hemodialysis patients when modifiers CB and CF and several other modifiers identified for the automated multichannel chemistry tests (AMCC) were appended that noted the service rendered were outside the composite rate.
First Coast Service Options Inc. (FCSO) continues to see a large number of errors identified by the Comprehensive Error Rate Testing (CERT) contractor for clinical laboratory services and diagnostic procedures. The errors are largely due to the absence of a physician's order on file or for failure to provide a copy of the order when documentation is requested. It is inappropriate to bill the Medicare program for clinical laboratory services and diagnostic procedures without a physician's order.
First Coast Options- MAC for Jurisdiction 9, which includes Puerto Rico, the U.S. Virgin Islands and Florida
Medicare pays for clinical laboratory services that are medically reasonable and necessary, ordered by a physician, and used by the physician in the treatment of the patient.
First Coast Service Options Inc. (FCSO) has seen a significant increase in the number of CERT errors related to the lack of a legible signature in medical record documentation. The CERT contractor confirmed that CMS and the OIG have clarified that providers of Medicare services must comply with the signature legibility requirements outlined in the Internet-only manual, Publication 100-08, Chapter 3, Section 3.4.1.1 B: