Question 1

What is HCPCS code M1109?

Accepted Answer

HCPCS code M1109 is "Oc ni pt dc". Ongoing care not medically possible because the patient was discharged early due to specific medical events, documented in the medical record, such as the patient became hospitalized or scheduled for surgery

Question 2

What category is M1109 in?

Accepted Answer

M1109 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1109?

Accepted Answer

Use M1109 when billing for oc ni pt dc. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is M1109 covered by Medicare?

Accepted Answer

Coverage for M1109 (Oc ni pt dc) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for M1109?

Accepted Answer

Documentation for M1109 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).