Neurology & Pain Management Coding Alert

Question: Do you have any suggestions for filing paper claims for unlisted-procedure codes? Our payer has said that we are not in compliance with its -timely filing- requirements.


New York Subscriber

Answer: Many payers require electronic claims as proof of timely filing. But on many occasions you must provide full documentation, and therefore you should file a paper claim--such as when filing claims with unlisted-procedure codes, or claims with modifier 22 (Unusual procedural services), 52 (Reduced services) or 53 (Discontinued procedure).

Solution: File the claim electronically and then submit paper documentation separately. 

Be sure to include a note with the paper claim explaining, -This is not a duplicate claim. This documentation supports an electronic claim.-

You can also indicate (in the electronic equivalent of box 19 on the electronic claim) which unlisted services you are submitting (such as 95999, Unlisted neurological or neuromuscular diagnostic procedure). Be sure to state clearly that you-re sending a hard copy of documentation separately.

File the paper claim within the payer's allotted time frame, as well. Don't wait for your carrier to reject your electronic claim before you file the paper claim. If you wait, your payer may say the electronic claim was incomplete and the payer didn't reset the clock for timely filing after receiving the electronic claim.