Cindy Posted Thu 05th of March, 2020 15:19:48 PM
CPT 64413 was deleted 01/01/20 and it says to use 64999. My provider did an injection into the lesser occipital and supraclavicular nerve distributions on the right side. Used 4 cc of buffered 5% dextrose and 1% lidocaine. We submitted this to Noridian using the 64999 since 64413 was deleted. We sent the description. Noridian refuses to process, stating unprocessable for missing/incomplete/invalid procedures code(s) even though we submit the description. Is there another code we could use? We have submitted this 3 times and you can't appeal. It is so frustrating. Not sure why the code was deleted. Thank you
SuperCoder Answered Fri 06th of March, 2020 05:54:46 AM
Thank you for your question.
CPT® 2020 deleted 64413. The AMA did not give a reason for this deletion, but it may have been under-reported. To report the injection of anesthetic agent and/or steroid to the cervical plexus, use 64999.
If you get a claim denied with services described in one of the deleted 2020 codes, be sure to check with the payer to see how you should report the service from now on.
Note: When reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes and compare your service to those codes to justify the claim amount you are billing. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial.
Hope that Helps!
Cindy Posted Fri 06th of March, 2020 06:38:36 AM
Noridian does not accept cover letters with their claims, you cannot file a paper claim nor do they accept documentation. You must put a written description on the electronic claim. Any other suggestions? Thank you
SuperCoder Answered Tue 10th of March, 2020 14:25:41 PM
So according to Noridian's instructions on how to report unlisted procedure codes. You are correct in stating that all all inofrmation must be indicated on the CMS 1500 form. An unlisted procedure or NOC code must have a concise description of the service or procedure rendered in Item 19 on the CMS-1500 claim form or electronic equivalent. In the concise description of the procedure, it is helpful to include how the procedure was performed (e.g. laparoscopic, transnasal, infusion, with clip, type of graft, etc.), the body area treated and why it was performed.
The electronic equivalent for Item 19 holds up to 80 characters for the concise statement. If the description does not fit in Item 19, providers who submit paper claims should include an attachment to describe the service or procedure. Also, an attachment can be submitted for EMC claims using the PWK submission method. See the blow link for Nordidan with teh detailed instructions for this process. Hope that helps!