Question Unlisted Codes and Medicare

paust57

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Has anyone had experience with billing unlisted codes with Medicare? I keep getting denials from Medicare for 64999 with the description Erector Spinal Plane. Medicare states that this is not a sufficient description for this code. They will not give you any clue as to what is a sufficient description. I am doing anesthesia billing and we have a practice that uses Erector Spinal Plane quite often. They have paid in the past but recently have started requiring the description in block 19 on the claim.
 
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Check your MAC for a fact sheet on unlisted/NOC codes. For example, WPSGHA gives some examples of good descriptions:
  • Stab Phlebectomy of Varicose Veins 1 Extremity 6 Stab Incisions
  • Pharyngeal scar band lysed with monopolar cautery
  • Arthroscopic decompression of the suprascapular nerve
  • Injection, Factor VIII FC Fusion (Recombinant), per IU: 25,000 units

I wonder if adding a couple of words, such as "Block of the erector spinae plane" Or "Injected [units of drug] into the erector spinae plane" would be enough. The only other thing I can think is they want you to submit the documentation on an appeal.
 
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