AAPC - Back to school
Results 1 to 2 of 2

Thread: Using unlisted codes for a Critical Access Hospital

  1. #1

    Default Using unlisted codes for a Critical Access Hospital

    AAPC: Back to School
    HELP!!! I work for a Critical Access Hospital and we are having trouble with unlisted procedure codes. We have received a transmittal that states that on March 2, 2010 CMS issued a memo to all Medicare contractors entitled "Critical Access Hospital (CAH) Method II Providers Notification." In this transmittal CMS states the following...

    "please be advised that effective April 1, 2010 claims submitted by a CAH Method II provider containing unlisted Healthcare Common Procedure Coding System (HCPCS) Codes for professional services (Revenue Codes 96X, 97X or 98X) will be returned. The CAH Method II provider will need to determine a more specific HCPCS Code for Unlisted procedures rendered by a physician before resubmitting the claim. Providers unable to detemine a more specific HCPCS Code can contact the AMA to request a code be assigned for the assiciatedc procedure:" Reference: JSM CI
    6520-10161; 03/02/10

    Is anyone else out there dealing with this?

  2. #2


    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.

    Good Luck!

Similar Threads

  1. Critical Access Hospital E/M coding
    By Sunnycat in forum Billing/Reimbursement
    Replies: 0
    Last Post: 10-14-2013, 11:00 AM
  2. Critical Access Hospital - Critical Access Hospital
    By angieg1215 in forum Critical Access Hospitals (CAH)
    Replies: 4
    Last Post: 01-19-2013, 03:22 AM
  3. Critical Access Hospital - COLOR="Navy"
    By Jacoder in forum Critical Access Hospitals (CAH)
    Replies: 0
    Last Post: 05-04-2011, 01:11 PM
  4. Critical Access Hospital
    By KFalzone in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-18-2008, 09:10 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.