Results 1 to 2 of 2

Can 38724 be done safely on out-pt basis?

  1. #1
    Monroe, NC chapter
    Question Can 38724 be done safely on out-pt basis?
    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. #2
    Sioux Falls South Dakota
    According to Medicare's fee schedule, this has an OPSI code of C - inpatient procedure. Also, it has an ASC indicator of C5, Inpatient procedure.

    I hope this helps,

    I didn't think to give you the link to the Medicare fee schedules - here it is:
    Last edited by cmcgarry; 06-25-2010 at 01:29 PM. Reason: Adding link to MPFS
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

Similar Threads

  1. Coding on a clinical basis
    By Coder85 in forum ICD-10
    Replies: 0
    Last Post: 12-09-2015, 03:47 PM
  2. Second request...need help with 42415,38724,42426
    By PattiW in forum Hematology/Oncology
    Replies: 1
    Last Post: 03-12-2012, 01:10 PM
  3. 2nd request for help with 42415/38724/42426 bundling
    By PattiW in forum ENT/Otolaryngology
    Replies: 1
    Last Post: 03-09-2012, 09:21 AM
  4. case rate basis
    By jmcpolin in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 03-06-2012, 11:13 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.