Stephanie Ellis: Code 64718 for a neuroplasty and/or transposition; ulnar nerve at elbow has 14.97 RVUs and code 29848 for an endoscopy, wrist, surgical, with release of transverse carpal ligament is only 13.00 RVUs, but I don’t know if the payor goes by groupers. If they don’t go by groupers, I would list the codes as 64718 followed by 29848 for the ASC and on the claim for a physician.
If the 29848 code has a higher grouper with the payor, then, of course, you listed them in the correct order.
My advice is:
• For Medicare claims, sequence CPT codes for billing from highest to lowest fee listed on the Medicare ASC list.
• Sequence CPT codes on claims from highest to lowest payment groupings for those other payors with which the ASC facility is contracted who use groupers.
• Sequence CPT codes on claims from highest to lowest RVUs for those other payors with which your facility is contracted who do not go by payment groupers or with whom your facility does not have a contract.
It sounds like you are doing it correctly and if they have paid you incorrectly, I would certainly pursue vigorous appeals.
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The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read more insight from Stephanie Ellis:
– Successful Appeals of Denied Claims
– Coder’s Guide to ASC and Physician Practice Modifiers
– 17 Orthopedic Coding Questions Answered By Stephanie Ellis
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