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Urology Coding Alert

Reader Questions:

Submit Electronic Claim First, Followed by Paper Claim

Published on Thu May 04, 2006

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, you must provide full documentation and therefore file a paper claim -- such as when filing for unlisted-procedure code claims or modifier 22 (Unusual procedural services) and reduced or discontinued service (modifier 52 or 53) claims.
 
The solution is simple: File the claim electronically and then submit paper documentation separately, especially when requested by the carrier. 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 to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.
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