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tobeornottobeacoder

Networker
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Canon City, CO
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Does anyone know if this procedure can be paid in the office???? I have a denial from Medicare saying this is not payable in the office setting. Our coding program is showing an allowable for the facility and non facility but the representative says this is not payable. When asked what LCD or policy name this information is located, they could not give me an answer and was just told we could appeal it. Anyone have any guidance on this. I have researched this CPT and I find not information that this procedure cannot be done in the office.

Help???
 
Your coding program doesn't pay your claims. What does your LCD say for this service and your provider type. Remember, payor guidelines can trump regular CPT rules. As long as its spelled out, proceed.

CMS will NEVER provide advice, LCD guidance or look-up. Go to your contract carrier for your region, search the code and/or provider specialty and read through. Have a cup of tea or coffee, some searches take a while.
 
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