Wiki 61650/61651 denied as inpatient only codes

[Tonyj]

I rec'd a denial because 61650/61651 was performed as an outpatient procedure and the insurance company is stating this should only be performed as an inpatient service. The global period in CMS website list a zero for the procedures. How do I appeal this denial or can I?

Codes 61650 and 61651 describe infusion therapy for intracranial arteries other than those used for thrombolysis.
Code 61650 is the base code and describes the service for the initial vascular territory treated. If additional vascular territories are treated, the add-on code 61651 is reported for each additional territory treated

 

[CodingKing]

Usually its just that facility that is denied. The codes have an APC Status indicator of C which means it should be done at an inpatient only.

 

[Tonyj]

Thanks for responding.
We do physician billing and I'm confused when you say it's the facility being denied. Can you please clarify?
Also, where can I find this information on my own?

 

[thomas7331]

CMS (in the OPPS facility reimbursement rules) has payment restrictions on certain types of procedures that CMS has determined should only be done inpatient (codes with status indicator C), and so will not pay a facility if billed as outpatient. This is a CMS facility reimbursement rule and does not apply to physician claims, so that's not really relevant if you're billing physician claim, or if your patient is not Medicare.

I'd recommend you contact the insurance company that denied this and find out what their policy is, and whether or not it's something you can appeal. It may have been an error on their part, but if not, they should be able to direct you to their written payment policies so that you can understand why this happened and what steps you can take to address it, if any.

 

[Tonyj]

Thanks so much for the information!