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MILD procedure coding question

  1. #1
    Red face MILD procedure coding question
    Exam Training Packages
    Hi all,
    Would appreciate any input. I know there has been a Cat III code released, 0275T lumbar. Is that only for the ASC's to use? Do providers still have to bill either 22899 or 64999 as referenced is the CPT Assistant Nov 2010?
    Thanks!

  2. #2
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    I didn't see 0275T on the Medicare approved ASC list. Once a category III code is established to describe the service, you can not revert back to using an unlisted code is my understanding. Looks like for a Medicare beneficiary, the MILD procedure is not a covered procedure for facility reimbursement in a ASC setting.

  3. #3
    Location
    Denver Colorado
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    279
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    Category III codes are for all providers use. The section guidelines for Category III codes states "If a Category III code is available, this code must be reported instead of a Category I code unlisted code."

    The November 2010 CPT Assistant article was written prior to the Category III code was released in January 2011 and effective date of July 2011. It was current at the time of the Q/A but now the Category III code should be reported rather than the unlisted code.

  4. #4
    Location
    St. Joseph County, Indiana
    Posts
    101
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    FYI: The coding for this in flux for many Medicare carriers. The previous code for MILD, C9729, was supposed to phased out on 7-1-11 and replaced with 0275T. However, several Medicare carriers, such as Indiana, have not loaded the new code. Perhaps the current ASC list has also not been updated.

    We have performed a dozen in a physician-owned hospital setting with no reimbursement problems....and they used the C9729 code.

    Brock Berta, CPC-A, MBA
    Billing Czar

  5. #5
    Default
    C9729 was for the hospital setting not freestanding ASC for Medicare. Below link does not show C9729 or 0275T on ASC approved list.

    https://www.cms.gov/MLNMattersArticl...ads/MM7443.pdf

    http://ascassociation.org/list2011.pdf

    http://ascassociation.org/changes2012.pdf

  6. #6
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    Morning,

    I just sitting down with the Vertos-MILD rep this morning to discuss coding. I was showing him this web site to show him what resources we use to help with coding questions.

    His response to the above answer: The code to use for ASC's is the 0275T. It is not currently on his CMS ASC list, probably because the code was just activated in July. It should be on the 2012 ASC list.

    From what he has heard, while reimbursement in a hosptial setting is very good for the facility, the allowed amount for an ASC will be much lower.

    Per Bob Dunlap, Vertos rep for Michigan, Ohio and Indiana.

    Brock Berta, CPC-A

  7. #7
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    2012 ASC List Changes. This document provides the procedures that were added to and deleted from the ASC list for 2012. The lists of additions and deletions include both separately payable as well as packaged procedures.

    http://ascassociation.org/changes2012.pdf

    The link has category III codes for 2012 such as 0282T but they do not show 0275T for 2012.

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