Question question on billing urology and stent

cherylbr

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We are are a Ambulatory Surgical Center billing Aetna insurance for codes 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) and implant code C2617 Stent, non-coronary, temporary, without delivery system.
Aetna is denying for "the services described by code C2617 are incidental to the total episode of care. Certain procedures are commonly performed in conjunction with other procedures as a component of the overall service provided. An incidental procedure is one that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure. Supplies, materials and equipment used in conjunction with a medical procedure are considered incidental to the primary procedure. No additional payment will be made for these items. Therefore, separate charges for code C2617 are not eligible for payment.
I am confused as our contract reads "implants revenue code 278 are to be paid at 100% of the invoice cost".

Again we are using HCPCS code C2617 with revenue code 278 (medical/surgical supplies other implants).

Why then are they denying us payment on the C2617 implant code?

Anyone else having this problem?

Can anyone advise?

Any help would be greatly appreciated!
Thank you,
Cheryl
 

nsteinhauser

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The C2617 has an ASC billing indicator of "N1" which is "Packaged service/item; no separate payment made". Maybe somewhere in the contract it reads that billing indicators supersede other allowances in the contract? Just a thought.
 
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