Wiki Billing CPT codes you know will not be paid.

[Judy Howard]

Please help. I am an office manager and my billing department does not want to bill a code that they know will not be paid. As a CPC and office manager, it is important to me for us to be accurate in all that we do and to me that includes billing procedures we perform, but may not be paid for. For instance, 36415 is not always paid by some payors. But, at the end of the year I would like to run a report telling me how many venipunctures we performed. I have also been a coding instructor, but I can not find this in writing. I also feel that it is dishonest to only bill what will be paid. I hope I am making sense and would welcome any advice. And, if I am wrong I will admit it to the billing department. Thanks!

 

[syllingk]

I thought that was the whole idea of an ABN.

 

[lypece]

is my understanding that you have to bill everything is done even if you make it worth $0.00 or $0.01 (if your system don't take the 0) the more a code is billed the more chances are that it will get approved and reimbursed. I just went to a chapter meeting it was mentioned that the cpt 53899-unlisted procedure, urinay system was used with supporting documentation. Resulting with the approval of the new code in 2013: 52287 (Cystourethroscopy, with injection for chemodenervation of the bladder.

 

[jaaroncpc@gmail.com]

Hello All,

Judy I concur with your reasoning particularly for reporting purposes.

I not familiar with anything in writing that I could point you to however as lypece stated above unlisted and category III codes should always be reported regardless of reimbursement so that the CPT Editorial Panel could consider permanent code assignment.

I have an article coming out in the December Coding Edge on this very issue.

Stay Tuned!