jwaldee
New
Hello. I am having a major issue with FSCO Medicare and their denial of CPT codes 22533 & 22534 due to "inappropriate place of service code" Prior to CY 2021 these codes were only permitted as inpatient, as per the Medicare Inpatient-Only list. However effective 1/1/2021 CMS has removed 298 codes from the list, beginning with Musculoskeletal codes. Per their 2021 list, the entire 20000 series codes are no longer listed as being inpatient only.
Fast forward to earlier this year and every single claim we have billed as POS 22 has denied for inappropriate POS code. We have filed appeals and sent the copy of CY 2021 Hospital-Inpatient Only list (codes that will ONLY be paid as inpatient) showing the CPT code is no longer there however they have upheld their denial by stating their decision was made per the CMS Medicare Claims Processing Manual, 100-04, Chapter 23, Section 20. I have reviewed this section more than 100 times and do not see anything regarding this matter there.
I currently have 1 of these appeals pending as Level 2 with C2C Innovative Solutions and am hoping for a better outcome.
Does anyone have any insight? The hospital was paid using POS 22 but we are not and I am beside myself because I really do not understand why FCSO is not accepting our documentation.
Thank you for listening and hope someone has some info!
Fast forward to earlier this year and every single claim we have billed as POS 22 has denied for inappropriate POS code. We have filed appeals and sent the copy of CY 2021 Hospital-Inpatient Only list (codes that will ONLY be paid as inpatient) showing the CPT code is no longer there however they have upheld their denial by stating their decision was made per the CMS Medicare Claims Processing Manual, 100-04, Chapter 23, Section 20. I have reviewed this section more than 100 times and do not see anything regarding this matter there.
I currently have 1 of these appeals pending as Level 2 with C2C Innovative Solutions and am hoping for a better outcome.
Does anyone have any insight? The hospital was paid using POS 22 but we are not and I am beside myself because I really do not understand why FCSO is not accepting our documentation.
Thank you for listening and hope someone has some info!