Does anyone have experience with billing the code 81479, The Current Procedural Terminology (CPT) code 81479 as maintained by American Medical Association, is a medical procedural code under the range – Tier 2 Molecular Pathology Procedures? We are particularly looking for payers that have the code in the fee schedule.
Please let me know any help is appreciated
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Unlisted Procedure Codes: 3 Tips
CPT® includes so-called “unlisted procedure codes” to report procedures or services for which there is no more specific code. Here are three tips to apply these codes, correctly. Tip 1: Unlisted Procedure Codes Are a Last Resort You should report unlisted procedure codes only when no other Category I or Category III CPT® code accurately […]
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Unlisted L-Code (L8699) and claim rejection
NOC or unlisted CPT/HCPCS codes and units – Medicare Regulations
The physician is has given units for HCPCS code J3490 since he injections at two different anatomical sites. But the insurance has denied units applied with J3490. Please confirm if any Medicare regulation sites or reference saying units are not accepted for unlisted or NOC CPT/HCPCS codes. TIA
Thanks,
SG
medicare and unlisted codes
Also, do you find that it’s necessary to send the report even if your concise description fits in box 19?
the relevant citations:
Medicare Claims Processing Manual Chapter 26, 10.4 says “Enter a concise description of an "unlisted procedure code" or a NOC code if one can be given within the confines of this box. Otherwise an attachment shall be submitted with the claim.”
Noridian says “An unlisted procedure code or NOC must have a concise description of the services rendered in Item 19 on the CMS-1500 claim form or electronic equivalent. The electronic equivalent for Item 19 on EMC submissions will hold up to 80 characters for the concise statement and should be enough space to describe the unlisted procedure code. If the description does not fit in Item 19, providers who submit paper claims should include an attachment to describe the services. PWK segment is provided. See PWK article titled "Submitting Paperwork (PWK) Electronically."”
ETA: I’ve emailed Noridian, but they can take up to 45 days to respond.
Unlisted 29999 for arthroscopic corocplasty or micfrofracture of greater tuberosity
I am struggling with an orthopedic office and an unlisted code of 29999, which I am using to code either an arthroscopic corocoplasty OR a micfrofracture of greater tuberosity. The surgeons office is not booking with this procedure and when we ask they say they are not going to do it, but end up doing it. The problem is with my Medicare patients, Medicare leaves it to their responsibilities, and I am not having them sign an ABN because the surgeon is stating he will not be doing that procedure. The surgeons office is not disclosing if they bill or not the 29999 (kind of shady). I need help with this code. Can the ortho clinic legally not bill this code even though it is on the op report? any advice would be helpful on this matter. I need something concrete to go to the surgeon ortho clinic about this, but I cannot find anything. Thank you
Unlisted Otorlaryngological service or procedure
When to Use Unlisted Codes
AMA’s Instructions for Use of the CPT® Codebook tell us, “do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using he appropriate unlisted procedure or service code.” The Instructions further note, “Each of these unlisted procedural code numbers (with the appropriate accompanying […]
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