Miriam Posted Thu 22nd of August, 2013 11:17:21 AM
I am having issues billing Medicare electronically for unlisted procedures. the claim is getting kicked out stating detailed description of service. procedure in question is '32999' for a J wire placement in the lung. Do you have any insight
SuperCoder Answered Fri 23rd of August, 2013 00:32:09 AM
Medicare reimburses practices for unlisted procedures. If you report an unlisted-procedure code, such as 32999 (Unlisted procedure, lungs and pleura), your carrier will reject your claim pending a review of documentation.
When you receive this initial decision from your insurer, you should send a paper claim with a copy of the operative report or chart notes and a short letter comparing the procedure that the physician performed to a similar procedure. You must also assign a fee for the service.
Referencing a similar procedure explains why you deserve the same amount of reimbursement that the comparable established code commands. In your letter, describe how long it took your physician to perform the procedure, the number of medical personnel who completed the surgery, and the level of complexity involved.
If your physician performed a radiofrequency ablation, you should report 32999, along with 76362 for the CT guidance.
If your physician performs this procedure often, consider meeting with your carrier's medical director as well as the medical directors for your non-governmental insurers. Describe the procedure, arrange for its coverage, and negotiate a mutually agreeable free in advance.
This way, when you submit the unlisted-procedure code with the report and approved ICD-9 codes, the claim will not undergo an individual review, but your carrier will approve the claim.
Medicare carriers consider radiofrequency ablation for destroying tumor cells an investigational service, so make sure your patients sign an advance beneficiary notice (ABN) before your physician performs that procedure.