AAPC - credentialing the business side of medicine

neonelena · #1 08-05-2010, 06:22 AM

Fellow coders!! is the NOVASURE device included in this procedure (58563) Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation...or there is a HCPC code that we can bill along with this cpt since the cost of this device is $1,220.00 and the representative for HOLOGIC is indicating the procedure is included and my boss is questioning this...need feedback please!!!

...by the way, this is a BCBS patient.

vdepta · #2 08-05-2010, 01:59 PM

For GYN procedures utilize A4649 for Novasure and A4264 for Adiana devices.
Vicki

Lisa Bledsoe · #3 08-06-2010, 07:13 AM

Quote:

Originally Posted by neonelena

Fellow coders!! is the NOVASURE device included in this procedure (58563) Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation...or there is a HCPC code that we can bill along with this cpt since the cost of this device is $1,220.00 and the representative for HOLOGIC is indicating the procedure is included and my boss is questioning this...need feedback please!!!

...by the way, this is a BCBS patient.

Are you talking about Novasure 58563 or do you mean ESSURE 58565? We are billing for Essure with 58565 and A4264 ($1220.00)...but we are having problems getting paid for the supply. In HCPCS this code has the boxed E which does state "for which separate payment is not provided". So, I think we got nailed when sold on doing this in the office. I'm trying to convince my docs NOT to do it in the office any more.

neonelena · #4 08-09-2010, 05:39 AM

Im talking about the Novasure...thank you all for your replies!

bench · #5 08-11-2010, 12:19 PM

For procedure 58563, Novasure device is payable but depends with your contract with the payers. If your contract with BCBS do not state that it is payable, you can't bill them nor rather deny that particular claim. I got paid with BS for the novasure just because our contract with them states that rev code 0279 is payable. But now the payment for 58563 includes the novasure but with a more higher reimbursement. I was not using the HCPC code since our contract does not state to bill with this code. So I guess, try to look for your contract if you are an in network and look if you have an allowance for extra ordinary supplies.