Category III codes

I have never used a category III code before, and am not sure how to price this. Our surgeon did an open reduction and internal fixation of severly displaced ribs on the left side, number 6, 7, 8 and 9. I don't see a CPT® code, but found a category III code of 0246T. Should I use this code versus an unlisted code, and if so, how do I determine the amount to bill. I have checked our Medicare Fee schedule, and do not see this code listed. Can you help me with this? Thank you.

Mar 5th, 2012 - nmaguire 2,606

re: Category III codes

Use of unlisted codes does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported instead of a Category I unlisted code.
http://www.ama-assn.org/resources/doc/cpt/cptcat3codes.pdf

Mar 6th, 2012 - happy 12

re: Category III codes

Thank you for the information. Would you have any suggestion on how to price a category III code? We currently use the Medicare allowed amount times a percentage, and since there is no allowed amount, I don't have any idea what to charge.

Mar 6th, 2012 - nmaguire 2,606

re: Category III codes

Physicians will need to estimate the work involved in providing the service. Find a service code equal to work involved and price accordingly. Determine your fee schedule for the Category III code using the same methodology as for unlisted procedures. If the Category III procedure is more difficult, increase your fee appropriately from the fee of the base code. If it is less difficult, lower your fee from the base code.