Wiki S&I Codes

[nikksatt]

I work for Vascular Surgery and we are running into the issue of denials after the procedure code has been authorized. Insurance is denying stating an S&I code should've been authorized as well, however, in the book under many different surgery codes it states S&I is included. Can someone please explain this to me? If we're not looking in the correct area for the S&I codes we need to figure out the solution because I was under the impression everything in the CPT book is what we go by?

 

[kdlberg]

Payers can require things to be billed a certain way, but if it's per their instructions, you are not committing fraud. This might be an instance where you want to try and speak to an actual person, so you know what they want. They may want the S&I on there but won't actually pay it.