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Pre Code
Unlock Payment for Unlisted Procedures with Pre-authorization
Begin documenting prior to the procedure to help win the bottom line battle.
Choosing the proper anesthesia code can be dicey sometimes when you are coding for a well-defined surgery. Begin tackling procedures that do not align with an anesthesia code; but then you are dealing with one of the biggest coding challenges: Getting proper payment for unlisted procedures.
Barrier: The medical policies for many payers include disclaimers that every benefit plan defines which services are included and which are not. The next time your doctor provides a service that does not fall neatly under a CPT code and you resort to 'unlisted, remember these tips to boost your changes of payments.
Get in touch with a CPT Code
You should find a way to relate the procedure to an existing CPT code as support for payment. What's more, explain how your physician's procedure differs to show why you did not select the existing CPT code.
Here's an instance: The anesthesiologist intubated and sedated a child with severe asthma before the child underwent Forane therapy under anesthesia. CPT does not include an anesthesia code for inhalation therapy; as such you will need to relate the procedure to an existing code. Enquire the anesthesia provider whether the value can be compared to a closed chest procedure. If not, enquire what base value is appropriate and report the procedure with that number of units and 01999.
Pre-Authorization plan
You should take steps toward payment before the procedure occurs. Make an attempt to obtain pre-authorization from the payer in writing, and include any relevant documentation.
Here's an instance: You are trying to obtain pre-authorization for a pain management procedure for which you will submit an unlisted code. Describe the patient's condition and how the pain is affecting her life and health. Include any information pertaining to clinical trials for the procedure conducted by recognized doctors, and a lay-term description of the procedure so that anyone reading the letter can understand. Teach the payer on the anticipated cost of care with and minus the procedure; let the payer know if how much money could be saved if the procedure is done to bring down the chance of future, more expensive procedures. In the end, include CPT codes with comparable levels of work and risk to help set reimbursement.
Bear in mind: Payers take claims with unlisted procedure codes on a case-by-case and settle on payment based on the documentation you provide. But unfortunately, claims reviewers frequently don't have a high level of medicinal knowledge and doctors do not always dictate the most informative notes.
Stay away from modifiers
Do not append modifiers to unlisted procedure codes since the unlisted procedure codes don't describe specific procedures.
Intention: A modifier (say for instance 23 Unusual anesthesia) indicates that a service or procedure identified by a specific CPT code has been changed by some circumstance, however not changed in its definition. Modifiers can also be used to provide additional information to a payer about a procedure. Unlisted procedure codes do not have a description for the modifiers to change.
CPT Assistant AMA:
CPT Assistant (April 2001) added support to this issue by saying that since unlisted codes don't include descriptor language that specifies the components of a particular service, there's no need to "change" the meaning of the code.
Final note: In the end, you should always stick to the AMA official coding guidelines unless your contract with a payer stipulates otherwise. If you have trouble with a payer processing any unlisted procedure code, then you may address the issue with the payer representative who may, in writing, direct your provider that it's OK to go for a CPT code not following the AMA CPT guidelines.
About the Author
We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
Does anyone have an unused City of Villains Pre order code?
I'm looking for a City of Villains preorder code or a presale disk that hasn't been used. I want it specifically for the "Wolf Spider" helmet, but if you have another one let me know as well.
The chances of obtaining one of these is near impossible especially as villians came out something like 4 years ago now.
Pre code Ginger