Wiki Hcpcs implant codes c1758, c2617, c1769

hbarney1

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Has anyone that works in a hospital having bundling/packaging issue with HCPCS C (implant) codes? I have one account (BCBS) that they performed a cystoscopy and used C codes for ureter stent (C2617), catheter (C1758) and a wired guidance which blue cross and blue shields denied reimbursement for these codes (These items do not meet BCBS TX implant reimbursement policy that states the item must remain in the body and cannot be reabsorbed). I have been getting multiple accounts with this scenario and wasn't sure if there is something that we can changed to get paid or not. I have been researching for about 2 weeks and not seeing anything that can change the account, and the HCPCS codes have been coded correctly. Is there something that I am missing that needs to be changed? I know that I can't use one code for all 3 HCPCS codes provided. Any help is appreciated.
 
Just my thoughts, but I don't think you're doing anything wrong in the coding here - it sounds to me like someone needs to review these situations against your facility's payer contracts and determine whether or not they are being paid correctly, not send them back for coding changes. Payment to hospitals for implants is a contractual matter, not a coding one. From a Medicare perspective, 'packaging' of a charge is not a denial - CMS payment methodology includes the reimbursement for these items into the APC payment rate made for the primary procedure. In such a situation, you would not expect to see a separate line-item payment for those items, but that does not mean that the item has been denied. If BCBS follows a similar method of paying case rates, then these claims may in fact have been paid correctly. But if the payer is not reimbursing according to your contract, then that it a matter that should be resolved through discussions with the facility's network representatives, not by trying to find alternative ways of coding.
 
I was trying to look at Medicare's guidelines on this issue but haven't found anything. Any idea where it would be on the CMS website ?
 
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