234: This procedure is not paid separately
On Call Scenario:
Claim denied as procedure code is not paid separately
↓
May I get the denial date?
↓
Which is the primary CPT code?
↓
Rep provides primary CPT code
↙ ↘
Yes No
↙ ↘
Check claim form both the CPTs What is the time limit to send
billed on same claim form or not corrected claim?
↙ ↘ ↓
Yes No What is the fax# or mailing address
↓ ↓ to send an appeal?
Can you please reprocess What is the time limit ↓
the claim as CPT is already to send corrected claim? How much is the time limit
billed with primary CPT? ↓ to send an appeal?
↓ What is the fax# or mailing ↓
What is the TAT for address to send an appeal? May I have the claim# and Call ref#?
reprocessing? ↓
↓ How much is the time
May I have the limit to send an appeal?
claim# and Call ref#? ↓
May I have the claim#
and Call ref#?
Important Note:
Claim denied as procedure code is not paid separately
↓
May I get the denial date?
↓
Which is the primary CPT code?
↓
Rep provides primary CPT code
↙ ↘
Yes No
↙ ↘
Check claim form both the CPTs What is the time limit to send
billed on same claim form or not corrected claim?
↙ ↘ ↓
Yes No What is the fax# or mailing address
↓ ↓ to send an appeal?
Can you please reprocess What is the time limit ↓
the claim as CPT is already to send corrected claim? How much is the time limit
billed with primary CPT? ↓ to send an appeal?
↓ What is the fax# or mailing ↓
What is the TAT for address to send an appeal? May I have the claim# and Call ref#?
reprocessing? ↓
↓ How much is the time
May I have the limit to send an appeal?
claim# and Call ref#? ↓
May I have the claim#
and Call ref#?
Important Note:
- If the rep does not provide the correct primary CPT code then assign the claim to the coding team to know the primary CPT code.
- When the coding team provides a response with the correct primary CPT code and that code is not available in the system then create that CPT and resubmit both codes.
- If you have access to the encoder, findacode, etc. tools then you can also find primary procedures details. When you find that CPT can be billed alone then call the insurance to reprocess the claim. If the rep refuses to reprocess the claim then send an appeal.
- Tools to Identify Bundle CPT Codes
Most of the time ins. denies that they are not gonna pay for individual Cpt of add on so what do we need to do for that claim?
ReplyDeleteAdd on codes need to be billed along with main primary CPT. These cannot be billed separately or alone. Please follow it while billing to avoid denial.
Delete