Billing and Coding Clarifications
Paperwork, paperwork – unfortunately it is a necessary evil. To help you complete your documentation correctly from the start, and get you paid in a timely manner, we have outlined a few billing and coding clarifications below.
Under the MFFS Montana Administrative Rules (ARM) 24.29.1433(11)(e) and 24.29.1433(12)(f), when additional reimbursement is requested for implants, MT003 must be used.
Cost thresholds are $10,000.00 for inpatient and $500.00 for outpatient hospital or surgery centers. Manufacturer invoices must be submitted as well as the operative record. An implant record and/or itemization provides information that can be very helpful with reconciling the invoice(s) for calculation of reimbursement.
Physical Rehabilitation and Time
The Department of Labor and Industry’s (DLI) adoption of the “Rule of 8’s” made documenting actual time spent on each modality and/or procedures essential in order to correctly calculate the total number of units payable.
8-22 minutes = 1 unit
23-37 minutes = 2 units
38-52 minutes = 3 units
53-67 minutes = 4 units
Please ensure your documentation clearly indicates actual modalities or therapies performed. If referencing a flow sheet, be sure it is included with the bill and other documentation. For further information please go to the DLI website .
99080/Medical Status Form
Filling out the Medical Status Form is not a billable service. It is to be included in the normal E/M visits. Please see ARM 24.29.1513 for more information.
Morphine Equivalent Dosing Letter – MT001
When billing for a response to the Morphine Equivalent Dosing Letter that is sent out when opioid medications are over 120 MED threshold per day use the Montana only code MT001
Please do not use 99080 or 99199 as these will be denied for incorrect code.