Wiki Unlisted Procedures

Create Wiki Sort by date
A

amelia04284

Contributor
Messages
12
Location
Kansas City , MO
Best answers
0
Does anyone have experience billing frequent Unlisted Procedure codes? Do you follow the guidance to send a cover letter with the claim?
 

Attachments

  • Unlisted Procedures.pdf
    68.4 KB · Views: 9
0
There are probably discussions about it in here if you search the forums for the word unlisted.
However, many or most payers do not want unsolicited documents with claims (unless WC etc.)
Medicare has a whole process for fax/pwk (fax paperwork) and the use of unlisted. Most of the payers will have a process for it.
If your practice is performing unlisted procedures a lot, it can sometimes be better to work with a payer and have it in the contract/reimbursement.
 
0
I've worked with emerging therapies using unlisted procedures. Since they are so new to the market (often just received Pre Market Approval by the FDA), there hasn't been a chance to get a code yet. Preauthorizations can help you mitigate risk of non-payment. Work with your payer and see if the manufacturer of any devices used in the procedure have resources for their clients. They are permitted to put data and info to help secure payment into a HUB, which is regulated by their compliance team, so you are able to use that data. HTH
 
0
When I bill unlisted, I include in the original electronic claim submission a comparison code and a few word description of the procedure, but not a cover letter. Usually the insurance will request more information, and I submit a letter after the request.
 
You must log in or register to reply here.
Top