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Cpt 62252

  1. #1
    Default Cpt 62252
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    Has anyone ever been reimbursed by Medicare on CPT 62252? If so, under what circumstance? We have never been reimbursed for this procedure inpatient or outpatient though we perform it in both settings. Any input would be greatly appreciated.
    Neurosurg

  2. #2
    Location
    North Carolina
    Posts
    3,126
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    We are paid for these. Normally, this is the only service being provided at the time of the encounter. We add the necessary modifiers if it's done during the global period. Also...don't forget this has a technical and professional component.

  3. #3
    Default 62252
    Rebecca, I was glad to get your reply. We are a neurosurg practice. I primarily audit E&M visits but this issue has flowed into my hands. Sometimes a patient comes into the office after an MRI to have the shunt reprogrammed. We have tried billing the 62252 and always get rejections. The question is, what do your physicians document and how? What is your place of service? Thank you for any input you can provide.
    Neurosurg

  4. #4
    Location
    North Carolina
    Posts
    3,126
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    We are a multispecialty practice. Neurosurgery is one of them. Usually, we perform these as an outpatient procedure (hospital). As for the documentation, typically the reason for the reprogramming is for a communicating or obstructive hydrocephalus. What type of rejections are you receiving?

  5. #5
    Default 62252
    I have been told by our billing staff it is associated with the place of service, clinic or while hospital inpatient. Procedure coding staff have not billed these in quite some time because they say they never have been paid for them in the past. Our physicians dictate these in E&M format for both inpatient and clinic visits. I realize they need to change this format to a procedure note but, what specifically do they dictate for the professional component? Do your physicians perform these in a radiology setting? Here, shunt settings are checked with the magnetic tool, adjusted if incorrect, then sent to the hospital for an xray to confirm the setting. The radiologist at the hospital also dictates his interpretation so, I am unsure if we need to work with the hospital when billing these for the Professional Component. The physician dictates what the xray of the shunt setting indicates and then the adjustment made. I am not sure what we need to change to get paid for these.
    Neurosurg

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