Do not use the open code for procedure when performing the service laparoscopically. Use an unlisted code if none exists. Contact your medical society and the CPT® committee to describe the service and advocate for a code.
Here is Nancy Maguire's response to this question on the Q&A forum:
For any "unlisted" code the payer will conduct a review to see:
- Whether the procedure or service requested by an unlisted code actually has a specific CPT® code that is more appropriate. An unlisted code must be medically necessary. This would include determinations of whether:
- There is a medical problem,
- The procedure is appropriate to address the problem,
- The procedure is of proven efficacy, and/or the standard of care
- Whether the site of service requested is appropriate
The coder should also review the Category III codes before assigning an unlisted code. If a Category III code is available, it must be assigned.
Do not recommend submitting an "open" code because that is not the technique described.
If there is another code that is similar to the one you are submitting as an unlisted code, let the payer know that in your cover letter. That will help with pricing.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
Clinical staff (e.g., LPN, RN, MA) provide essential services which allow providers to leverage their time and improve reimbursement opportunities and run their practices more efficiently. There is, however, an ongoing question of how to appropriately bill for clinical staff time. This is really a complex question which comes down to code descriptions, federal or state licensure, AND payer policies. Failure to understand licensing and payer policies led a Connecticut provider organization down a path that ended in a $273,000 settlement with both federal and state governments.
hile many provider groups offer some imaging services in their offices, others may rely on external imaging centers. When the provider reviews images performed by an external source (e.g., independent imaging center), that is typically referred to as an overread or a re-read. Properly reporting that work depends on a variety of factors as discussed in this article.
The role of SDOH in overall patient care and outcomes has become a more common topic of discussion among healthcare providers, payers, and policymakers alike. All are attempting to identify and collect SDOH and correlate the data to patient management which is increasingly seen as necessary to address certain health disparities and identify exactly how SDOH affects patient health outcomes. Learn how to address this important subject.
A biopsy is a procedure to obtain only a portion of a lesion for a pathologic exam. According to the AMA, "The use of a biopsy procedure code (e.g., 11102, 11103) indicates that the procedure to obtain tissue for pathologic examination was performed independently, or was unrelated or distinct from other ...
Just like math teachers who require students to show their work so they can see how the student reached their answer, providers are also required to "show their work" through the documentation process in the medical record. By the time a provider has reviewed the patient's subjective complaints (i.e., patient's ...
To accommodate the new COVID-19 immunizations the CPT editorial panel has approved 11 Category I codes. Watch for new and revised guidelines and parenthetical notes with these codes. For example; which administration codes should be used with the vaccine codes and the NCD codes applicable to the dose being administered. These ...