General Surgery Coding Alert

Question: We had a case that involved a procedure performed in late December that we did not bill out until January. It turned out that the procedure code was deleted for the new year, and the payer denied the claim. What can we do to get payment for this service?

Georgia Subscriber

Answer: The provider should not deny the claim if the code was valid for the procedure date of service and you have filed the claim within the timely filing guidelines (usually within 12 months of the date of service). If you’ve met those guidelines, you should appeal the claim denial.

On the other hand, if you performed the service after the procedure code became invalid, say early January, the denial would be valid. That’s why you should always pay attention to the effective dates of code deletions, revisions, and additions to ensure that you’re reporting your claims accurately.