Wiki Medicare transmittal 2636

[EmilyDingee]

I just looked into this. Medicare was supposidly doing an edit on codes 93623,93621 & 93609 parentetical code sets. I pulled the transmittal above from CMS and there are no new changes as of April 1st! Unbelievable! The new EP codes were made to include ablation and EP study and we are not getting payment on the above codes due to primary procedure code not being billed When the EP study code 93620 is inclusive in the new EP Ablations! My appeals are not being paid and I thought for sure this edit would be the answer to these denials!

 

[theresa.dix@tennova.com]

I just looked into this. Medicare was supposidly doing an edit on codes 93623,93621 & 93609 parentetical code sets. I pulled the transmittal above from CMS and there are no new changes as of April 1st! Unbelievable! The new EP codes were made to include ablation and EP study and we are not getting payment on the above codes due to primary procedure code not being billed When the EP study code 93620 is inclusive in the new EP Ablations! My appeals are not being paid and I thought for sure this edit would be the answer to these denials!

Exactly the transmittal is just confirming and making more clear.

 

[jewlz0879]

Jim Collins has some GREAT information on this and it helps direct coders. Basically, CMS overrides AMA, which stinks, but that is what we have to work with.

CMS instructions override CPT instructions and CMS says we cannot report these add-on services with the new ablation codes. Other than being able to report mapping (93609 or 93613) with the new SVT ablation code (93653), we should not be reporting any of these five add-on services (93609, 93613, 93621, 93622, 93623) with any of the new ablation codes. This represents a substantial reduction in reported RVUs and the associated revenue.

HTH