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unlisted cpt

SuperCoder Posted Wed 14th of September, 2011 19:43:17 PM

would it be correct to bill a unlisted procedure (76496) more than once on a hcfa 1500

SuperCoder Answered Thu 15th of September, 2011 03:16:37 AM

Yes. You could bill more than once unlisted Px. on CMS-1500 form. Need to enter concise desc. of unlisted or NOC code within the confines of this box. While billing more than one unlisted Px code, precede each description in item 19 with the line item number that corresponds to the line that contains the NOC code. This will allow claims processing staff to determine the correct desc. for each unlisted Px code. If billing the same unlisted Px code more than once on the claim, you may need to signify the charges of the procedure codes to indicate which description belongs to each line.

SuperCoder Answered Thu 15th of September, 2011 03:35:01 AM

Billing 76496 multiple times is not logical and doesn't go with the billing concept involved. Whenever you bill any Unlisted procedure, you need to bill this along with medical records with mentioning justification for expected level of reimbursements which will used once for all those procedures for which 76496 should have been used multiple times if it had not been an unlisted procedure.
Second reason is that modifiers like 59 or 76 are not allowable with 76496. This gives sufficient indication of the usage of this code.

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