Worker's Compensation reimbursement

SA91

Contributor
Messages
17
Location
Nacogdoches, TX
Best answers
0
Hi all!

Please may someone advise on this?:

Is there anyone biller/collector/coder that has submitted a CPT 62380 (2017) code to any W/C carrier and refused payment reimbursement due to an old W/C fee schedule that the carrier uses? If so, what other alternative code may we use to receive reimbursement (we have submitted code 99199 (2000) but it is not efficient for this type of procedure).

I would really appreciate any suggestions!

Stay well and regards,
Lisa.
 

SA91

Contributor
Messages
17
Location
Nacogdoches, TX
Best answers
0
Hi,

Yes and we have disputed this with the carrier, apparently there is a disclaimer stating the following: All the authorizations have disclaimers on them that there is no guarantee of payment which is the way all auth’s read regardless of the company.

I have tried using the authorization as a legitimate reason in which they obviously managed to get out of?
 

klamond

Networker
Messages
45
Location
Hamilton
Best answers
0
Try 62287. That was the previous code used for the procedure so should be on the WC fee schedule.

"Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar CPT® adds 62380 to replace 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection at the treated level, when performed, single or multiple levels, lumbar) for a partial discectomy with an endoscopic approach, as well as Posterior Extradural Laminotomy or Laminectomy for Exploration/ Decompression of Neural Elements or Excision of Herniated Intervertebral Disks Procedures codes 63020-63035. "
 

SA91

Contributor
Messages
17
Location
Nacogdoches, TX
Best answers
0
Try 62287. That was the previous code used for the procedure so should be on the WC fee schedule.

"Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar CPT® adds 62380 to replace 62287 (Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection at the treated level, when performed, single or multiple levels, lumbar) for a partial discectomy with an endoscopic approach, as well as Posterior Extradural Laminotomy or Laminectomy for Exploration/ Decompression of Neural Elements or Excision of Herniated Intervertebral Disks Procedures codes 63020-63035. "

Hi!

Thank you for that information! I have located the code in the AMA CPT 2019 and it does not say "endoscopic"? Where did you quote this from or resource did you use if I may ask?

I appreciate the help!
 

klamond

Networker
Messages
45
Location
Hamilton
Best answers
0
Hi!

Thank you for that information! I have located the code in the AMA CPT 2019 and it does not say "endoscopic"? Where did you quote this from or resource did you use if I may ask?

I appreciate the help!
No problem at all. We deal with this for WC and MVA often. They don't update their fee schedules for years! If you can't access the link I sent, I can email it to you.
 

SA91

Contributor
Messages
17
Location
Nacogdoches, TX
Best answers
0
No problem at all. We deal with this for WC and MVA often. They don't update their fee schedules for years! If you can't access the link I sent, I can email it to you.

Thank you for that much appreciated! Absolutely! And they were smart by adding the disclaimer stamps on the authorization letters to avoid paying. If this does not work most likely I will try and file an appeal with the State itself so they can get on this carrier to pay us.

I will keep this thread posted :)
 

klamond

Networker
Messages
45
Location
Hamilton
Best answers
0
Thank you for that much appreciated! Absolutely! And they were smart by adding the disclaimer stamps on the authorization letters to avoid paying. If this does not work most likely I will try and file an appeal with the State itself so they can get on this carrier to pay us.

I will keep this thread posted :)
I also have the historical information from AAPC Codify if you'd like me to email it to you. I cant attach a link because you have to be a subscriber.
 
Top