Appropriateness of Coding to the Highest Reimbursing Procedure: Q&A With Stephanie Ellis of Ellis Medical Consulting

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Stephanie Ellis, RN, CPC, is the president of Ellis Medical Consulting.
 
Q: I’m having an issue with an insurance carrier on multiple procedures. I sent in a claim with the primary code of 29848 and 64718 as the secondary.  I did this because the 29848 has the higher allowance/value over the 64718. The insurance carrier has reversed the codes, which reduced our allowance by over $800. I called the carrier and spoke with the representative and explained what they did, and this is not how the claim was submitted. She advised me the reason for the reversal is that this is the correct standard coding process for these two codes. From what I know and do, it is always appropriate to code the highest allowed procedure. Even on the Medicare website, it indicates they will process the higher code first. Was I correct in using the 29848 as the primary code?  Am I correct in basically all cases to use the highest allowed code as the primary code for ASC billing?

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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.

 

Learn more about Ellis Medical Consulting.

 

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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