Wiki ins co requesting ICD-10-PCS codes


Black Hawk, SD
Best answers
I work in an ASC and recently we've had a couple of insurance companies reject our claims because they are asking for ICD-10 PCS codes. Since we are billing for outpatient, not inpatient, we use CPT. Has anyone else had this issue?
Id contact the payer as PCS is for inpatient claims. I now some facilities internally require PCS but that is optional and not required for billing outpatient.
That can be tricky because it could be a few things. The very first thing I would check is your type of bill. If your type of bill was an inpatient bill type, it will want an inpatient code. Rather than deny stating wrong type of bill, they will say they want PCS diagnosis. It's silly. I find a lot of times, it's a bill type problem though. Another thing I would check is your procedure code. Sometimes the CPT you report is an Inpatient Only procedure so they want the PCS diagnosis codes to go along with it. This updates constantly so it may have been outpatient before but now it's not. Last time, some insurance companies require that you send the PCS code along with your other codes. I know at where I'm at we use the 3M coding software and it automatically prompts us to code the PCS on everything, even a lab. You can check with your payer contracting and see if that's something they can ask for according to your contract with them.