Neurosurgery Coding Alert

Question: We have difficulty filing paper claims for unlisted-procedure codes. Our payer says we are not in compliance with -timely filing- requirements. Do you have any suggestions?

New York Subscriber

Answer: Many payers require electronic claims as proof of timely filing. But on many occasions -- such as when filing claims for unlisted-procedure codes or claims with modifier 22 (Unusual procedural services) and reduced or discontinued services (modifier 52 or 53) -- you must provide full documentation and therefore file a paper claim.
     
The solution is simple: File the claim electronically and then submit paper documentation with a separate claim.
 
Be sure to include a note with the paper claim explaining that -This is not a duplicate claim. This documentation supports an electronic claim.- Be sure Medicare, which has recently implemented new rules about such practices, doesn't reject your paper claim as a duplicate anyway and delay your electronic claim so that they can request additional documentation.

 -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery.