Wiki Category III

[kskiles]

Hi,

I have a doctor that is being denied for code 0246T because its a investigation code. What information is needed to appeal this? Or is there another code that can be used. The patient had an open internal fixation of 4 ribs unilateral. The guidelines as I understand them is if there is a Category III code for a procedure then that code is to be used. Please help.

Thank,
Kim

 

[sparkles1077]

Yes, they have to be reported and they are typically denied as they are emerging tech services. Providers are encouraged to submit information to support future coding and use of these emerging tech services. Check your local LCD policy. Here is some info on Noridian LCD :33683:

Category III (T codes) codes may be noncovered (when addressed by a specific LCD) or covered (when addressed by a specific LCD or article). This LCD constitutes formal notice that the Category III codes listed below will be denied as not reasonable and necessary. (Your code is on the list)

Note: If members of the medical community believe that a Category III code represents an emerging technology, service, or procedure that has been proven safe and effective and would be reasonable and necessary for a specific indications;copies of published peer reviewed literature and other clinical and scientific information supporting the effectiveness of the therapy should be submitted to the Contractor Medical Director for re-consideration. With adequate scientific support, the Category III code will be removed from the policy and the service will be reimbursed for that indication.