Wiki Help with code 36837

[csrigney26@outlook]

I am new to Urology and one of the procedures our providers perform in our ambulator surgery clinic is CPT 36837. I just found out that this code is non-covered for our Virginia Medicaid patients. I was wanting to know if there is another CPT code I'm missing. Any help someone can give me would be much appreciated.

 

[Pam Warren]

It is impossible to tell without reviewing the documentation as to whether this is the correct code or not. If it is, then you cannot (and should never) try to report an alternative code simply to receive payment. That would be an example of a violation of the False Claims Act.
Make sure 36837 is truly the code that reports the procedure performed---and also if it's a code that should be performed in other than an ASC (per Virginia's state guidance). Is pre-authorization required? Is it bundled into another type of service Look into all possible options.