N.J. Admin. Code § 10:62-1.12

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:62-1.12 - Inpatient hospital services

(a) To qualify as documentation that the service was rendered by the practitioner during an inpatient stay, the beneficiary's medical record must contain the practitioner's notes indicating that the practitioner personally:

1. Reviewed the beneficiary's medical history with the beneficiary and/or his or her family, depending upon the medical situation;

2. Performed an eye examination, or other procedure;

3. Established, confirmed or revised the diagnosis; and

4. Visited and examined the beneficiary on each date of service for which a claim for reimbursement is made.

(b) An initial hospital visit during a single admission shall be disallowed to the same physician, group, shared health care facility, or practitioners sharing a common record who submit a claim for a consultation and transfer the patient to their service.

(c) When performing corneal tissue transplant surgery, providers shall request and receive prior authorization for HCPCS V2785 (processing, preserving and transplanting corneal tissue). Ophthalmologists shall submit the completed "Request for Prior Authorization of Optical Appliances" to Division staff with the provider's laboratory invoice attached to the request.

1. Ophthalmologists shall not bill for V2785 when the procedure is performed in a hospital.

N.J. Admin. Code § 10:62-1.12

Amended by 49 N.J.R. 2279(b), effective 7/17/2017