Wiki billing an open code to avoid using an unlisted laparoscopic CPT.

[amy.brown@ttuhSc.edu]

Situation is....the procedure in question does not have a laparoscopic CPT to bill so the surgeon wants the open code billed instead of the unlisted laparoscopic code for that area. Does anyone have experience with this and where can I get a hard copy of a guideline stating what the acceptable practice is so I can give this to the dept chair. PLEASE HELP!

 

[twizzle]

Situation is....the procedure in question does not have a laparoscopic CPT to bill so the surgeon wants the open code billed instead of the unlisted laparoscopic code for that area. Does anyone have experience with this and where can I get a hard copy of a guideline stating what the acceptable practice is so I can give this to the dept chair. PLEASE HELP!

Situation is....the procedure in question does not have a laparoscopic CPT to bill so the surgeon wants the open code billed instead of the unlisted laparoscopic code for that area. Does anyone have experience with this and where can I get a hard copy of a guideline stating what the acceptable practice is so I can give this to the dept chair. PLEASE HELP!

I'm afraid your provider cannot bill for something they didn't do just because it's more convenient. It is called 'fraud' and comes under the False Claims Act and payers take a very grim view of it. There are no guidelines required to make the point but this might be worth showing to the dept. chair. https://www.cms.gov/.../MLNProducts/Fast-Facts/False-Claims.html

 

[amy.brown@ttuhSc.edu]

I'm afraid your provider cannot bill for something they didn't do just because it's more convenient. It is called 'fraud' and comes under the False Claims Act and payers take a very grim view of it. There are no guidelines required to make the point but this might be worth showing to the dept. chair. https://www.cms.gov/.../MLNProducts/Fast-Facts/False-Claims.html

Thank you very much for your quick response to my issue. This is exactly what my partner and myself explained so thank you for backing it up.

 

[CodingKing]

Its also listed in the CPT book in the introduction page xii under Instructions of use of the CPT Codebook:

Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code.