ED Coding and Reimbursement Alert

Question: In your article last month, “Compare Your Claims Against This MAC’s Top Denial Reasons,” it said that if the procedure code was invalid on the date of service, that’s a reason for denial. What about if we forget to file a claim, and by the time we file it, a code has been deleted and is no longer valid? For instance, suppose the date of service is Dec. 20, but we don’t file the claim until Jan. 25, and by that point, the CPT^® code has been deleted. What can we do?

Codify Subscriber

Answer: As long as the code was valid on the date of service and you’re filing the claim within the timely filing guidelines (usually within 12 months of the date of service), then you are billing correctly in sending the now-deleted code to the payer.

The denial would come if you performed the service on Jan. 2 and submitted the claim on Jan. 25 using the code that went out of service at the end of the prior year. Because the code was deleted as of the date of service, then you would be facing a denial. Therefore, you should always pay attention to the effective dates of code deletions, revisions, and additions to ensure that you’re reporting your claims accurately.