Get Solesta Coding & Billing Instructions - Ub-04 Claim Form - ...

Filing the Solesta Coding & Billing Instructions - UB-04 Claim Form can be straightforward if you follow the correct steps. This guide will provide you with a clear, step-by-step overview for successfully completing the form online.

Follow the steps to fill out the form accurately.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin filling out the patient information in Field 8, ensuring that you enter the correct name and date of birth. Double-check the accuracy of all details provided.
3. In Field 46, enter the number of units of Solesta to be billed. Remember to bill four (4) units for the L8605 code, as it is based on 1 mL.
4. In Field 44, enter the unique HCPCS code for Solesta, which is L8605. This code indicates the injectable bulking agent for anal canal.
5. Select either CPT Code 46999 or HCPCS Code C9735, based on your payer, to represent the Solesta procedure. This information should be entered in Field 42.
6. For diagnosis codes, enter the appropriate ICD-9-CM codes in Field 67, such as 787.60 for full incontinence of feces, based on the patient's diagnosis.
7. Fill in the revenue codes, including 0278 for other implants, in Field 42. Ensure that you verify with the payer for the correct revenue code requirements.
8. Review all entries for accuracy before submitting the claim. Once complete, you can save changes to the form, download it for future reference, print a hard copy, or share it directly.

Start filling out your documents online for efficient and accurate submissions.