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Medicare Compliance & Reimbursement

Part B Coding Coach:

4 Steps Unlock Ethical Unlisted Procedure Coding Payments

Published on Sat Oct 16, 2010

Referencing the nearest equivalent CPT code could be your key to getting paid. When CPT forces you to turn to unlisted codes, such as when your physician performs a laparoscopic uterosacral nerve ablation (LUNA) procedure, make sure you follow these simple steps or you could up with zilch. Step 1: Never Select a 'Close but Not Quite' Code You should never report a code that comes close to the procedure your ob-gyn performed, but doesn't quite fit. If no precise procedure or service code exists, you should report the service "using the appropriate unlisted procedure or service code," state the CPT Instructions for Use in the CPT manual.CPT includes unlisted-procedure codes to allow you to report procedures for which there is no specific CPT descriptor available.Payment for such claims, however, is not automatic.Your doctor must make a careful effort to document the procedure,and the information you include with your claim [...]
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