Get Paid for New Procedures And New Technologies
Published on Wed Mar 01, 2000
Neurosurgeons often learn of new procedures and technologies that may help to provide a better quality of care to patients. But a significant period of time may elapse between the introduction of such techniques and technologies to neurosurgeons and the assignment of a CPT code to describe these procedures. Neurosurgeons who wish to gain reimbursement for new procedures and new technologies should be aware of the potential shortcuts to reimbursement and the potential pitfalls of incorrect billing.
Helen Hinkle, CPC, billing and coding specialist for 10 neurosurgeons in the department of neurosurgery at the Emory Clinic in Atlanta, gives just one example: Our pediatric neurosurgeons perform endoscopic shunting. And because there is no specific code for it, I will use either 64999 (unlisted procedure, nervous system) or 62230 (replacement or revision of CSF shunt, obstructed valve, or distal catheter in shunt system) or 62223 (creation of shunt; ventriculo-peritoneal, -pleural, other terminus) with the -52 reduced services modifier.
Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a Dallas, Ga.-based consulting firm and an advisory board member for the American Academy of Professional Coders, says that any procedures not listed in the CPT are considered by report procedures. The carrier will generally desire a written report regarding the procedure, including any relevant surgical records before reimbursement is issued. If a new test is performed or a new piece of equipment is used or a new therapy is introduced, precise and thorough documentation of the neurosurgeons applications and any patient improvement will help to expedite claims. Medical necessity should also be indicated. The carrier wants to know exactly what they are paying for and why, Parman says.
Even with documentation, claims involving new procedures and new technologies may be denied and appeals may need to be launched. A neurosurgeon may have to convince a local insurance company medical director to give a ruling on reimbursement.
Parman suggests that the neurosurgeon put together information about the procedure not only from his or her perspective, but also from peer-reviewed medical journals. Explain what the new procedure is, what it does, and if it has received approval from the federal government via the FDA [federal Food and Drug Administration], Parman says. Further, a neurosurgeon should explain to the medical director the benefits the carriers enrollees can expect to receive from the new procedure or technology, including any statistical studies detailing its effectiveness. The specific use of the new procedure or technology also should be explained.
To determine an acceptable reimbursement rate, a code should be analoged (see box on page 25). In essence, the neurosurgeon explains the similarity of the unlisted procedure to the closest existing CPT coded [...]
