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Non covered service

Robyn Posted Tue 19th of January, 2016 18:43:52 PM

For MO MCD we have been told that 43249 is a non-covered service for ASCs. We wouldn't be able to just bill 43235 and leave off the dilation by chance?

SuperCoder Answered Wed 20th of January, 2016 02:35:54 AM

Please check your payer's policy for the specific code.

Please refer to sections 10.2 (Ambulatory Surgical Center Services on ASC List) and 40.5 (Payment for Multiple Procedures) of the Medicare Claims Processing Manual, Chapter 14 - Ambulatory Surgical Centers. These may answer all your questions.
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c14.pdf
I hope that helps!

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