Yes I have had this happen. It is a little troubling that they (CMS) is pretty much stating that you need to go back to the provider and ask them to compare the px they did to another like px that may have a billable CPT code. Um in my book that would not be correct coding.
Or CMS is stating to contact the AMA to create a code that better describes the px. Um pretty sure that that is not gonna happen any time soon. And what would be the reasoning for our request? "O because CMS won't pay for this unlisted px code." That probably isn't a real feasible request that the AMA will take seriously.
Our facility has reported unlisted codes and will continue, not that it is the norm. But there are instances that warrant the reporting of an unlisted code. Some of which are at the direction (parenthetical notes) of the AMA Professional Edition CPT coding book. I do not work in the BO but I am pretty sure these do get sent back to our coders for a second look and normally get unchanged, thus we just eat the charge because of no reimbursement. Don't hold me to that but I think that is what happens.
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