Wiki 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.
 
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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