Wiki Can 38724 be done safely on out-pt basis?

[bungalowgirl]

I need help finding some written proof of Medicare's position that they consider a certain CPT code as payable either as in-pt OR outpt... Another ins company has denied proc. 38724 (done on out-pt basis @ hospital) as POS inconsistent w/procedure. When I called the ins company, they said their policy was based on MC's policy that this proc. should be done in-pt. Well, I called MC to confirm, and the rep I spoke w/ ck'd, and said they'd consider it a payable code combination to be done on out-pt basis. I asked for site for written documentation of that, and rep said it wasn't posted anywhere on CMS site, it was just in their 'internal system'. Even my ENT Coding Companion does not give that kind of info on different codes... Can anyone suggest site, book or other resource where that kind of information about cms in-pt/out-pt policy is given? Thanks...

 

[cmcgarry]

According to Medicare's fee schedule, this has an OPSI code of C - inpatient procedure. Also, it has an ASC indicator of C5, Inpatient procedure.

I hope this helps,

I didn't think to give you the link to the Medicare fee schedules - here it is:
http://www.cms.gov/PhysicianFeeSched/PFSRVF/list.asp