Take Vital Steps Toward Unlisted Procedures Payment

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.”

Anesthesia and Pain Management CANPC

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.

Latest posts by admin aapc (see all)

Read the complete Article

Login as a member or sign up for free to get uninterrupted access to AAPC blog posts and stay updated on industry news through our monthly newsletter.

2017-code-book-bundles-728x90-01

Leave a Reply

Your email address will not be published. Required fields are marked *