Ashley Posted Wed 29th of June, 2016 10:55:06 AM
We have offices in several different states and have not had an issue billing the above services at POS 11 except for Kentucky they are denying our claims stating that these cpt codes can not be done in POS 11. CGS can not direct us to anything stating this within the CMS guidelines and they do not have an LCD on these codes. do you have any suggestions on how we can appeal this we are currently drafting a letter to CGS Medical Director but not sure how much luck we will have. thanks
SuperCoder Answered Thu 30th of June, 2016 06:00:23 AM
CPT code 37227 and 37229 are inpatient codes stating revascularization procedures which cannot be performed in Out patient settings (POS 11).
Ashley Posted Thu 30th of June, 2016 13:42:58 PM
but can you direct me to where you got this information because CGS said they could not direct me to anything in writing on this as they only have and internal edit and OHIO,GA and AL all pay for these procedure in POS 11 and I also have Medicaid Replacement in KY paying for these procedure in KY. Thanks
Ashley Posted Thu 30th of June, 2016 13:44:18 PM
KY also has allow amounts for these codes if preformed in a NON Facility setting on the CGS website.
SuperCoder Answered Fri 01st of July, 2016 09:33:36 AM
Our team is working on it and we will get back to you soon.
Ashley Posted Wed 06th of July, 2016 10:24:26 AM
thanks for the help let me know what you find out because I am unable to locate anything about a restriction for these code on POS.
Ashley Posted Fri 08th of July, 2016 07:57:05 AM
I just wanted to let you know we sent a let to CGS and they are working on fixing this glitch in the system so that these codes now reflect the POS 11 as a paying services. thanks
SuperCoder Answered Fri 08th of July, 2016 08:53:57 AM
Hope this gets fixed soon.