Contents Aspen™ Spinous Process Fixation System Reimbursement Guide Section 1: Overview...............................................................................................................
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Section 2: Introduction – Understanding Aspen Spinous Process Fixation System.....................
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Background...........................................................................................................
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Section 3: Coverage................................................................................................................
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Benefits and Medical Necessity...............................................................................
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Sample Letter of Medical Necessity..........................................................................
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Patient Selection Criteria........................................................................................
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Preauthorization Process .......................................................................................
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Section 4: Physician Coding and Payment................................................................................ 10 ICD-9-CM Diagnosis Codes.................................................................................... 10 CPT Codes/Physician Services................................................................................. 11 Modifiers.............................................................................................................. 14 Section 5: Unlisted Procedure Code Billing............................................................................. 15 Section 6: Unlisted Procedure Code Submission Attachments/Templates.................................. 17 Unlisted Procedure Form........................................................................................ 17 Description of Unlisted Procedure Using the Aspen System....................................... 18 Sample Preauthorization Letter.............................................................................. 19 FDA Clearance Letter............................................................................................. 20 Section 7: Hospital Inpatient Coding and Payment................................................................... 23 Payment Methodologies.......................................................................................... 23 Diagnosis Related Groups (DRG’s).......................................................................... 23 Case Rates and Per Diems....................................................................................... 23 ICD-9-CM Diagnosis Codes.................................................................................... 24 ICD-9-CM Procedure Codes................................................................................... 24 Revenue Codes....................................................................................................... 25 Section 8: Outpatient Coding and Payment.............................................................................. 26 Section 9: Denials.................................................................................................................. 27 Sample Appeal Letter............................................................................................. 28 Sample Operative Report........................................................................................ 29 Section 10: Frequently Asked Questions.................................................................................. 30 Section 11: Bibliography........................................................................................................ 33 Hotline: 855.438.5269 | Email: reimbursement@lanx.com
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