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Finding Documentation to Support MC's position

  1. #1
    Location
    Monroe, NC chapter
    Posts
    25
    Question Finding Documentation to Support MC's position
    Medical Coding Books
    I need help finding some written proof of Medicare's position that they consider a certain CPT code as payable either as in-pt OR outpt... Another ins company has denied proc. 38724 (done on out-pt basis @ hospital) as POS inconsistent w/procedure. When I called the ins company, they said their policy was based on MC's policy that this proc. should be done in-pt. Well, I called MC to confirm, and the rep I spoke w/ ck'd, and said they'd consider it a payable code combination to be done on out-pt basis. I asked for site for written documentation of that, and rep said it wasn't posted anywhere on CMS site, it was just in their 'internal system'. Even my ENT Coding Companion does not give that kind of info on different codes... Can anyone suggest site, book or other resource where that kind of information about cms in-pt/out-pt policy is given? Thanks...

  2. Default Finding documentation to support mc
    Quote Originally Posted by 2hands View Post
    I need help finding some written proof of Medicare's position that they consider a certain CPT code as payable either as in-pt OR outpt... Another ins company has denied proc. 38724 (done on out-pt basis @ hospital) as POS inconsistent w/procedure. When I called the ins company, they said their policy was based on MC's policy that this proc. should be done in-pt. Well, I called MC to confirm, and the rep I spoke w/ ck'd, and said they'd consider it a payable code combination to be done on out-pt basis. I asked for site for written documentation of that, and rep said it wasn't posted anywhere on CMS site, it was just in their 'internal system'. Even my ENT Coding Companion does not give that kind of info on different codes... Can anyone suggest site, book or other resource where that kind of information about cms in-pt/out-pt policy is given? Thanks...
    I have always found what I needed here:

    http://www.cms.gov/mcd/search.asp?from2=search.asp&

    This is the CMS search engine for all national and local coverage determinations. It has several ways to search -by HCPCS, CPT or key word, date, etc.

    Melanie

  3. #3
    Location
    Monroe, NC chapter
    Posts
    25
    Default
    Thanks, but the Medicare Rep I spoke with said that wouldn't be posted anywhere on their website...I will give it a try, but am not holding out much hope. I'm wondering if there is some outside resource (coding assist.book, website etc) that includes that information...

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    According to CMS, this is an inpatient only procedure. A procedure listed with a status indicator of "C" is deemed inpatient status only...

    38724 Removal of lymph nodes, neck --->C<---

    Open addendum B under the "downloads"

    http://www.cms.gov/HospitalOutpatien...tNumPerPage=10

  5. #5
    Location
    Monroe, NC chapter
    Posts
    25
    Default
    Thank you Rebecca! I wouldn't have even known how to interpret that, but this is so helpful! Now I know how I need to proceed...

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Happy to help!

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