Even more fun with Medicare CPT® 51999

page 304 of my 2014 CPT® codebook lists CPT® 51999 as valid - "Unlisted laparoscopy procedure, bladder".

Medicare (NORIDIAN) is denying this code on several patients stating it is an invalid code and that I need to recode the claims. I have called and the "customer service" reps argue and keep stating it is an invalid code. I have no appeal rights due to the denial reason.

Any suggestions? Comments? Similar issues with a Medicare contractor?

Thanks.

re: Even more fun with Medicare CPT® 51999

I have increasingly seen over the past couple of years that a payers are denying unspecified/unlisted codes. Also hearing it more & more in my training workshops.

It may be that this payer is moving in the same direction. If there is no other code to describe the service, including the use of any modifiers, you will need to submit the procedure note, explain clearly why this unlisted code must be reported & go from there.

re: Even more fun with Medicare CPT® 51999

Yes, I billed this with notes initially. I spoke to a Noridian rep and she told me they do not have this code in their system, which I find somewhat odd. It is commonly billed by specialists. Anyway, I am waiting for Noridian to research and get back to me.