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ECMO add-on denials

  1. Default ECMO add-on denials
    Medical Coding Books
    We are getting denials from several different insurance companies for the way we are billing CPT 33961. We are a billing company for physicians, which means we bill each claim per date of service. When a patient has the initial ECMO (CPT 33960) it is billed on one claim because it is usually one date of service and the subsequent ECMO (CPT 33961) is billed on another claim because it is usually a different date of service. The CPT book does state to use CPT 33961 in conjunction with 33960 however it also states that CPT 33960 is for the initial 24 hours and CPT 33961 is for each additional 24 hours. We can't seem to get the insurance companies to understand why these services are being billed on separate claims.

    Is anyone having problems like this? If so do you have any suggestions as to what we can do?

    Thanks!

  2. #2
    Location
    Bridgeport, CT
    Posts
    10
    Default ECMO Denials
    Good morning,

    CPT 33961 states "Prolonged extracorporeal circulation for cardiopulmonary insufficiency; each additional 24 hours (List separately in addition to code for primary procedure) " This service as designated by CPT is an Add on code and may never be reported alone.

    If you are performing 48 monitroing, you would report 1 unit of CPT 33960 and 1 unit of 33961. The most likely reason you are receiving denials is the editing software the payor is using, could be processing the add on code first and there is no historical claim on file for the primary code.

    Have you contacted the insurance companies Appeals unit? That might be the easiest way to get to the bottom of the issue.

    I hope this helps.

  3. Default
    Thank you...I do send appeals in for these denials. Some of the insurance companies are still denying the appeals. In most cases CPT 33960 is being processed first. In my appeal I go into great detail about how we bill the claim and why it is billed that way. I may have to get someone higher in charge involved.

    Thanks again!!

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default What's your primary procedure?
    Wouldn't you have a primary procedure ... critical care? Subsequent hospital visit?

    I don't work in critical care any longer, but I know we used the 33961 along with 99291 and got paid in the past.

    F Tessa Bartels, CPC, CEMC

  5. Default ECMo and Pedictric Critical Care Codes
    Hi!

    I am trying to find info that states the physician CAN bill pediatric critical care codes with the ECMO codes, if you know where to find this info, I would greatly appreciate it.

    Thanks
    MaryBEth

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Pediatric Critical Care
    Read the guidelines for Pediatric Critical Care codes in your CPT book. ECMO is NOT listed as a code that is bundled.

    F Tessa Bartels, CPC, CEMC

  7. Default
    You do need a primary code, but the parenthetical note for 33961 indicates that 33960 is the primary code for this add-on code.

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