|press Friendly Version|
|Effective Date:||August 1, 2005|
|Issued Date:||August 1, 2005|
|Date critical Reviewed:||06/2005|
general Policy Guidelines
Tensilon experimentation is one integral component of the doctor"s medical care and also is not eligible as a distinct and also separate service. If tensilon experimentation is reported on the very same day as clinical care, and also the charges room itemized, incorporate the charges and pay only the clinical care. Payment because that the medical treatment performed on the same date of organization includes the allowance for the tensilon testing. A participating, preferred, or network provider cannot bill the member independently for the tensilon trial and error in this case.
If the tensilon experimentation is carry out independently, procedure it under the proper code(s).
Modifier 25 may be reported v medical care to recognize it as a significant, independently identifiable company from the tensilon testing. When the 25 full is reported, the patient’s documents must clearly document that separately identifiable medical treatment has to be rendered.
Payment for tensilon tonography need to be processed under procedure code 92120.
Tensilon testing (95857, 95858) is carried out by method of one intravenous injection the tensilon (edrophonium chloride) adhered to by monitoring of the patient for boosted or lessened ocular muscle function. That is used mostly for the diagnosis the myasthenia gravis.
Tensilon tonography differs from routine tensilon testing in that a tonogram is provided to measure intraocular pressure. Tensilon tonography is excellent only once the routine tensilon trial and error is equivocal or inconclusive.
Managed treatment POS Guidelines
see Previous Versions
This policy is design to deal with medical guidelines the are appropriate for the bulk of people with a specific disease, illness, or condition. Each person's distinct clinical circumstances may warrant separation, personal, instance consideration, based on review of applicable clinical records.Medical policies are design to complement the terms of a member's contract. The member's contract specifies the services available; therefore, medical policies need to not be understood as overriding particular contract language. In the event of conflict, the contract candlestick govern.Medical policies do not constitute clinical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines because that coverage and reimbursement under mountain State Blue cross Blue Shield plans. Applications of a medical policy to recognize coverage in an individual circumstances is not intended and also shall not be interpreted to supercede the professional judgment of a dealing with provider. In all situations, the treating provider must use his/her expert judgment to administer care he/she trust to be in the ideal interest of the patient, and the provider and also patient continue to be responsible because that all therapy decisions.Mountain State Blue cross Blue Shield (MSBCBS) maintain the right to review and also update its medical policy guidelines at its sole discretion. This guidelines room the proprietary information of MSBCBS. Any sale, copying or circulation of the medical policies is prohibited; however, minimal copying of medical policies is permitted for separation, personal, instance use.