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implants questions

  1. #1
    Location
    NEW ORLEANS
    Posts
    954
    Default implants questions
    Medical Coding Books
    IS there any ASC 'S getting paid by private insurance companies on implants on porth a caths , lens, etc. Is there a list of payable implant, screws, etc. Here is my problem . Where I work at I'M consider a coder not a biller, so I dont see all the payments of how much we get reimbursed. . Here and there I'L ask but I do many other things to keep very busy . The billers tell me they get denied on just about every claim when I code an implant . They say its not in the contract. It seems a lack of communication on who is in charge of the contracts. So , is there any suggestions someone can give me, or a web site I can go to for I can go to my supervisor and explain this, Our ASC is missing out on some revenue, , I know Medicare does not pay for them, but reading these forums I see others have no problems getting reimbursed on imlants. I just got certifified, Now a CPC , trying to do my job, the right way . THANKS AGAIN , TRENT

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by trent123 View Post
    IS there any ASC 'S getting paid by private insurance companies on implants on porth a caths , lens, etc. Is there a list of payable implant, screws, etc. Here is my problem . Where I work at I'M consider a coder not a biller, so I dont see all the payments of how much we get reimbursed. . Here and there I'L ask but I do many other things to keep very busy . The billers tell me they get denied on just about every claim when I code an implant . They say its not in the contract. It seems a lack of communication on who is in charge of the contracts. So , is there any suggestions someone can give me, or a web site I can go to for I can go to my supervisor and explain this, Our ASC is missing out on some revenue, , I know Medicare does not pay for them, but reading these forums I see others have no problems getting reimbursed on imlants. I just got certifified, Now a CPC , trying to do my job, the right way . THANKS AGAIN , TRENT
    Hi Trent,
    I know you and I have spoke about this on many occasions. Yes, ASC's can be reimbursed based on contracts. Since your billers state "its not in the contract", then I would definitely go to the higher ups and get them to renegotiate the contracts to accomodate these. A possiblity is that maybe your contracts are "rich" (meaning they pay higher) to accomodate for these but I have never seen an ASC do that simply because the amount of implants and fees vary from case to case.
    Good Luck, I know this has been a sore spot for you for quite some time now.
    Mary, CPC,COSC

  3. #3
    Location
    NEW ORLEANS
    Posts
    954
    Default Thanks
    Thanks Mary, But is there a list of payable ASC implants codes that I can present to my supervisor on paper that is . Actual document that is, I like to show them on paper . If you find something or now of something please email me at E-mail Address(es):
    tjhardy1966@bellsouth.net

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by trent123 View Post
    Thanks Mary, But is there a list of payable ASC implants codes that I can present to my supervisor on paper that is . Actual document that is, I like to show them on paper . If you find something or now of something please email me at E-mail Address(es):
    tjhardy1966@bellsouth.net
    there isnt a list exclusive for ASC's that I am aware of. In an ASC we use the C codes and L codes from the HCPC code book. There are also a couple of V codes that are used for eyes cases as well. Some of the codes I use most frequently are:
    C1713
    C1781
    C2625
    C1788
    L8600
    L8680
    L8699
    C1776
    C1762

    I know that there are MANY more, I just don't use them regularly so they arent in my brain today

  5. #5
    Default
    I use V2785 for corneas in an ASC. Medicare pays after they request a copy of the invoice since we bill the actual cost of the cornea. Some private carriers will pay without the invoice; one I have to send additional documentation, but they are always paid. We did have the same issue with implants not being included in our contract but we did renegotiate our contract and the claims were paid.

  6. #6
    Location
    NEW ORLEANS
    Posts
    954
    Default
    thanks this is a start

  7. Red face Implant coding
    Hello

    I am new to implant coding also, therefore, any advice or information on that subject would appreciated. I am following up rejected Implant claims to Anthem BCBS in Virginia.

  8. #8
    Default
    I am in Pennsylvania and I can tell you that I have to submit corneal implants to our local Blue Shield differently than any other carrier. I would call your provider rep and ask exactly how they want implants submitted. Also, are implants included in your contract? If not, it should be added and they should then process the claim. Keep fighting for payment. Good luck.

  9. Default Implant coding
    Thank You

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