CMS-Organ donor complications

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Temporary Workaround Billing for Organ Donor ComplicationsMay 11th, 2012 Medicare will now separately pay for complication services for a person who donates an organ to a Medicare beneficiary, according to the Centers for Medicare & Medicaid Services (CMS) change request (CR) 7816. With customary claims, the patient is always the beneficiary, so the patient relationship has always been a one-to-one match. When a person donates an organ, however, the one-to-one patient relationship no longer exists.CMS has a temporary workaround to allow 837I claims for organ donor complications into Medicare systems. According to MLN Matters® article 7816, to code claims for organ donor complications during the temporary process, providers should:Show the patient relationship of 18 (Self) in Form Locator (FL) 59 (Patient’s Relation to Insured) on all 837I claims. Submit the Medicare beneficiary’s information in the following FLs: 08 (Patient Name/Identifier), 09 (Patient Address), 10 (Patient Birth Date), and 11 (Patient Sex). Add a value of 39 along with the donor’s name to the 837I Loop 2300, Billing Note Segment NTE02 (NTE01 = ADD). Providers using the UB-04 paper claim and direct data should:Show the patient relationship of 39 (Organ Donor) in Form Locator (FL) 59 (Patient’s Relation to Insured); and Submit the Medicare beneficiary’s information in the following FLs: 08 (Patient Name/Identifier), 09 (Patient Address), 10 (Patient Birth Date), and 11 (Patient Sex). Tina M. Shearer Donate Life TennesseeTransplant Financial Coordinator Cannon Center for Blood Cancers2300 St3N Parkview/BMTNashville, TN 37203 phone fax