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Thread: Can 38724 be done safely on out-pt basis?

  1. #1
    Join Date
    Apr 2007
    Monroe, NC chapter

    Question Can 38724 be done safely on out-pt basis?

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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

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