Wiki cpt 34812.. How to get this paid?

[cfernando]

Hi, is there any way I can get this add-on code 34812 (open, artery exposure) paid without my surgeon assisting or doing the main procedure cpt 34705 (endovascular aortic repair) which was done by the other surgeon? My manager explained it to my doctor that 34812 was revised and it is now and add-on code. My doctor only did the artery exposure for the other doctor and left the room after that.

Could someone please guide me on how I can get this paid?

Thank you.

 

[cpc2007]

Hi, typically when a procedure reported with an add on code is done as a stand-alone procedure, the AMA as well as Dr. Z who is a well-known consultant for vascular/endovascular procedures recommends reporting an unlisted code. It's not possible to bill the add on as a stand-alone code without a valid primary without getting a denial. So in your case, I would recommend unlisted code 37799 linked to the fee of 34812 to give your doctor credit for his portion of the procedure.

I hope that helps

Kim
www.codingmastery.com

 

[mrsalexander]

34812

Hi, typically when a procedure reported with an add on code is done as a stand-alone procedure, the AMA as well as Dr. Z who is a well-known consultant for vascular/endovascular procedures recommends reporting an unlisted code. It's not possible to bill the add on as a stand-alone code without a valid primary without getting a denial. So in your case, I would recommend unlisted code 37799 linked to the fee of 34812 to give your doctor credit for his portion of the procedure.

I hope that helps

Kim
www.codingmastery.com

Kim - I am also having problems since 34812 became an add-on code. Do you have any type of reference from Dr. Z that you can share that recommends using 37799 and since it is unlisted, I am assuming they are going to request the op note, so have you been getting paid with the unlisted code from Medicare?? my e-mail:bbarnard@wmhs.com
thanks so much!

 

[cpc2007]

Unfortunately the guidance is in a Q&A blog from Dr. Z. Since you have to have a subscription and password to login and view the information, I cannot share it publicly. I have billed unlisted codes in similar circumstances though in cardiology and have been paid. You are correct that once you submit the claim, the payer will typically initially deny and ask for op notes to support why you are using an unlisted code. Another thing you will want to do is provide a brief description of the procedure and pricing on the claim (so in your case something like "stand-alone femoral artery cut-down; EVAR" with the price of 34812 to give the payer a gauge of the work that went into performing the procedure and increase the chances they will reimburse you accordingly).

I hope that helps

Kim
www.codingmastery.com