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Could we use HCPCS code `S8431`?

Lori Posted Thu 18th of April, 2013 17:07:43 PM


As pediatricians could we use HCPCS code S8431 for an ACE bandage? We had submitted a claim to a private insurance with CPT code 99070 which is a supply code we use for any ACE bandages, splints, etc. we apply on a patient. However, one insurance said we need to resubmit our claim with the appropriate HCPCS code for the supply. Would S8431 for an ACE bandage be the appropriate HCPCS code to us? Please advise. We thank you again!

SuperCoder Answered Mon 22nd of April, 2013 13:55:33 PM

Hi there! It depends what you're billing the ACE bandage with. If it's a strapping procedure, payment the supply (the bandage itself) may already be included in the payment for the procedure. Please let me know which CPT code you're billing with the ACE bandage (and your place of service - office vs. hospital) and I'll research whether the bandage is separately billable. Thanks!

Torrey Kim, CPC, CGSC
Editor, Pediatric Coding Alert

Lori Posted Tue 23rd of April, 2013 14:49:48 PM

Ok, thanks..

We billed CPT codes 99213 and 99070 on the original claim which they denied on the CPT code 99070 for not using a HCPCS code. The patient came in for ankle sprain (845.00, ankle sprain, nos was the diagnosis code used ) and we wrapped it with an ACE bandage. This was done in a pediatric PCP office. We appreciate your help with this matter.

SuperCoder Answered Wed 24th of April, 2013 01:37:31 AM

In that case, you can absolutely support billing for the ACE bandage separately with the office visit code. The more specific the code for the product, the better. In this case billing the HCPCS code S8431 would be the most specific code vs. the non specific generic 99070, which is often problematic.

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