Pulmonology Coding Alert

Question: Do you have any suggestions for filing paper claims for unlisted-procedure codes? Our payer says we are not in compliance with "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 file a paper claim -- such as when filing claims with unlisted-procedure codes or claims with modifier 22 (Unusual procedural services) and reduced or discontinued services (modifier 52 or 53).
 
The solution is simple: File the claim electronically and then wait for the request to submit "additional" (paper) documentation separately. This will provide you with a tracking mechanism as proof of when the claim was submitted and subsequently rejected pending review of records.
 
Be sure to include a note with the paper claim explaining that "This is not a duplicate claim. This documentation supports an electronic claim."

 -- Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.