This is exactly why Category III codes are established. They are temporary codes and frequently are testing new technology or new procedures to see how often they are performed. I would definitely attempt to get pre-auth from a commercial payer for the procedure. The doctor may need to write a letter explaining why this procedure is better than any other alternative treatment for the patient and include any literature available on the pros and cons for the procedure. Some payers will authorize payment if a case can be effectively made that this is the best treatment. The more this is done, then it will show the need to this procedure to "graduate" to a regular CPT code. There have been instances where Medicare has allowed a procedure which has a temporary code.
Originally Posted by barbara45
The problem is when folks just bill the code without doing some work ahead of time to see what it takes to get the procedure authorized. Research the procedure and get more information from the physician who wants to perform it.
Arlene J. Smith, CPC, CEMC, COBGC
AAPC Tacoma WA Chapter
Past-President 2013 and 2011
Member Relations 2008
AAPC NAB 2007-2009