# Finding Documentation to Support MC's position



## bungalowgirl (Jun 16, 2010)

I need help finding some written proof of Medicare's position that they consider a certain CPT code as payable either as in-pt OR outpt... Another ins company has denied  proc. 38724 (done on out-pt basis @ hospital) as POS inconsistent w/procedure. When I called the ins company, they said their policy was based on MC's policy that this proc. should be done in-pt. Well, I called MC to confirm, and the rep I spoke w/ ck'd, and said they'd consider it a payable code combination to be done on out-pt basis. I asked for site for written documentation of that, and rep said it wasn't posted anywhere on CMS site, it was just in their 'internal system'.  Even my ENT Coding Companion does not give that kind of info on different codes... Can anyone suggest site, book or other resource where that kind of information about cms in-pt/out-pt policy is given? Thanks...


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## MMAYCOCK (Jun 17, 2010)

*Finding documentation to support mc*



2hands said:


> I need help finding some written proof of Medicare's position that they consider a certain CPT code as payable either as in-pt OR outpt... Another ins company has denied  proc. 38724 (done on out-pt basis @ hospital) as POS inconsistent w/procedure. When I called the ins company, they said their policy was based on MC's policy that this proc. should be done in-pt. Well, I called MC to confirm, and the rep I spoke w/ ck'd, and said they'd consider it a payable code combination to be done on out-pt basis. I asked for site for written documentation of that, and rep said it wasn't posted anywhere on CMS site, it was just in their 'internal system'.  Even my ENT Coding Companion does not give that kind of info on different codes... Can anyone suggest site, book or other resource where that kind of information about cms in-pt/out-pt policy is given? Thanks...



I have always found what I needed here:

http://www.cms.gov/mcd/search.asp?from2=search.asp&

This is the CMS search engine for all national and local coverage determinations. It has several ways to search -by HCPCS, CPT or key word, date, etc. 

Melanie


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## bungalowgirl (Jun 17, 2010)

Thanks, but the Medicare Rep I spoke with said that wouldn't be posted anywhere on their website...I will give it a try, but am not holding out much hope.   I'm wondering if there is some outside resource (coding assist.book, website etc) that includes that information...


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## RebeccaWoodward* (Jun 17, 2010)

According to CMS, this is an inpatient only procedure.  A procedure listed with a status indicator of "C" is deemed inpatient status only...

38724	Removal of lymph nodes, neck	--->*C*<---

Open *addendum B* under the "downloads" 

http://www.cms.gov/HospitalOutpatie...descending&itemID=CMS1232221&intNumPerPage=10


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## bungalowgirl (Jun 17, 2010)

Thank you Rebecca!  I wouldn't have even known how to interpret that, but this is so helpful! Now I know how I need to proceed...


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## RebeccaWoodward* (Jun 17, 2010)

Happy to help!


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