Anesthesia Coding Alert

Keep these 4 tips in mind when submitting claims with unlisted codes

When you submit a claim with an unlisted procedure code (such as 64999, Unlisted procedure, nervous system), you want to include all the appropriate documentation. Follow these four suggestions from Myriam Nieves, CPC, ACS-PM, owner of the consulting firm Precision Medical Systems in Ft. Lauderdale, Fla., and Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver, to score high marks with your carrier:

1. Send a three-paragraph letter with your claim. The first paragraph should explain why you selected an unlisted code for the procedure. Next, explain why the service was necessary (let the carrier know it's not experimental). Finally, explain the fee you-re requesting and the rationale for it. Note which CPT code you based your claim on and why.

2. Always include a copy of the operative notes. The physician's notes should include a medical necessity statement that helps justify the procedure. Also add a comment in Box 19 of the CMS-1500 form such as -dorsal root ganglion, RF- to give the carrier a heads-up about the claim.

3. If possible, send published articles supporting the efficacy of the procedure. Including diagrams (such as algorithms) with your cover letter is also helpful.

4. Talk with your physician to determine the most appropriate or valid CPT code for comparison. Example: Codes 64622-64627 are a good comparison when you-re reporting 64999 for radiofrequency of the dorsal root ganglion. You shouldn't report 64622-64627 for the procedure because they don't reflect the correct anatomical location, but they are fairly similar in terms of work and risk.