General Surgery Coding Alert
File New Claim if ‘Unprocessable’
Question: We received an “unprocessable” claim from our MAC. Can we appeal this? Ohio Subscriber Answer: No, you can’t appeal an unprocessable claim because, technically, it was never filed. Another term for” unprocessable” is “rejected.” Rejected claims never enter the adjudication process as denials do. If a claim is deemed unprocessable, the reopening unit won’t be able to handle it. The CMS Internet-Only Manual describes an unprocessable claim as any claim with incomplete or missing required information, or any claim that contains complete and necessary information that proves invalid. Remark code: If your remittance advice lists MA130 as the reason code, then you know that the claim is unprocessable — which means it wasn’t processed. That means you have no appeal rights because the claim wasn’t denied. Do this: Your only option in this scenario is to correct the errors and resubmit the claim for processing.
General Surgery Coding Alert
- General Surgery:
‘PICC’ the Best Code for Venous Access
Use this Q/A flowchart to accurately report PICC procedures. When you face an op report [...] - Physician Fee Schedule:
Prepare for Large 2021 Conversion Factor Cut
Expect changes due to COVID-19, too. The Medicare Physician Fee Schedule (MPFS) 2021 proposed rule [...] - ABN:
Update Beneficiary Notification to Protect Your Surgeon’s Bottom Line
Don’t let deadline reprieve fool you. Not getting paid for a surgical procedure because you [...] - You Be the Coder:
Get Details for Cyst Fluid Specimen Case
Question: Our surgeon obtained a sample of fluid from an ovarian cyst under ultrasound guidance [...] - Reader Questions:
File New Claim if ‘Unprocessable’
Question: We received an “unprocessable” claim from our MAC. Can we appeal this? Ohio Subscriber [...] - Reader Questions:
Maintain NPI Across State Lines
Question: Our general surgery practice is moving from Louisiana to Texas. Do our surgeons need [...] - Reader Questions:
Beware Adhesiolysis Bundles
Question: During a splenectomy procedure, the surgeon documents encountering dense adhesions involving the bowel and [...]
