Claims edit software

Quartz ensures proper coding and billing by activating updates to the claims edits software system throughout the year. Quartz follows CMS coding directives as the authoritative source for correct coding and billing guidelines. We encourage you to refer to our Provider Manual and/or visit the CMS website to learn more about Medicare NCCI MUEs. Some recent updates include:

  • Clarification email regarding bilateral procedures and modifier details on December 13, 2023.  When submitting claims for bilateral procedures, you should use modifier -50 and note 1 unit. Quartz would not expect to see RT/LT combined with -50 or RT/LT on two separate lines used in place of a -50 on a single line. As a reminder, Quartz does follow CMS guidelines for bilateral procedures.
  • Effective with claims received on or after April 1, 2024, Quartz will require HCPCS modifiers GN, GO, or GP to be reported with codes designated by CMS as “always therapy” for all lines of business. You must furnish these services under a physical therapy, occupational therapy, or speech-language pathology plan of care as they are always considered therapy, regardless of who performs the service.  Service providers must be qualified and recognized by Medicare to perform these services.  Appending the modifier does not allow for services to be rendered outside of the provider’s scope of practice. Application of the appropriate modifier does not guarantee payment of the service, and correct coding guidelines should be followed.

A few items to note for correct coding and billing:

  • Unlisted codes require a description of the code or clinical documentation.
  • Colonoscopy following a positive Cologuard screening should be considered preventive as opposed to diagnostic.
  • Claims from dental providers require a diagnosis and should be billed with CPT codes, if possible, when in a medical facility setting.
  • Diagnosis codes should be as specific as possible, including laterality when applicable.
  • Please include time stamps in line detail to avoid confusion with repeat procedures that don’t require a specific modifier.

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