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Getting paid for unlisted procedure codes can be tricky, especially if a procedure is experimental or investigational.
“It’s not unheard of to get paid for unlisted procedures, but it’s not always easy,” says Joanne Mehmert, CPC, CCS-P, in Kansas City, Mo. “The insurance company has its own definition of medical necessity.”
An article in Anesthesia & Pain Management Coding Alert (Vol. 10, No. 11) says there are three steps you can take to make coding unlisted procedures less of a guessing game and improve your chances for obtaining payment.
Step 1: Get the payer to define “medical necessity.”
Step 2: Try to obtain preauthorization from the payer in a letter.
Step 3: Study your payer’s policies.
For details, read “How to Obtain Reimbursement for Unlisted Procedures” on the Coding Institute’s Web site.