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What You Don't Know About Pass-Through Can Hurt You

You know that transitional pass-through payment offers increased reimbursement for innovative devices, drugs, and biologicals - but you may not know the ins and outs of when to bill for them. Take stock of these expert tips and find out what to do when C codes expire or the doctor breaks a device.
Remember: Transitional items generally have a two- to three-year incubation period, after which their temporary codes either expire or become permanent.
Tip #1: If you're reporting an item with expired pass-through status, make sure you report its costs under the appropriate revenue code on the UB-92, says Arlene Baril, MS, RHIA, vice president of HIM and software services at United Audit Systems Inc. in Dallas. For example, if you report a C code that expired and has been deleted, you will receive a line-item rejection on the claim, says Baril, who presented on APCs at the 75th Annual AHIMA National Convention in Minneapolis. CMS lists the appropriate revenue code centers for expired pass-through codes in program memorandum A-01-50. To view the current pass-through items, visit .
Tip #2: When a device that qualifies for transitional pass-through payment breaks, you may be able to earn reimbursement if you know when to bill. Medicare won't pay you for devices that fail or turn out to be defective, Baril says, but if the device failure was the physician's fault, you can get paid for it. And in such a case, the government will not only reimburse you for the broken device but also pay you separately for the replacement device.

- Published on 2004-01-01