Medical Billing Forum

Coding => Coding => Topic started by: rcmbilling123 on November 16, 2017, 02:14:17 PM

Title: Sending Dummy CPTs
Post by: rcmbilling123 on November 16, 2017, 02:14:17 PM
Without going into the details, we would like to add made up CPTs to claims. These made up CPTs would all have a $0 charge. To the best of my knowledge, there isn't a modifier that generally excludes a CPT for consideration of a claim. My question is will an insurance company deny the entire claim if we include an invalid CPT? Or will they just deny the one line?
Title: Re: Sending Dummy CPTs
Post by: kristin on November 16, 2017, 04:04:38 PM
I recently had this happen with a doctor. He insisted I bill certain PQRS codes on his claims, although I knew they would not be accepted by Medicare and some Medicare Advantage plans through Aetna and UHC. Lo and behold, all the claims denied in full because of the PQRS codes. Luckily, I only put about ten through to prove my point to him. So while I cannot answer your question definitively, I can say from my experience that the whole claim denied for one invalid line on each claim.
Title: Re: Sending Dummy CPTs
Post by: PMRNC on November 16, 2017, 04:11:05 PM
What is the purpose of this?
Title: Re: Sending Dummy CPTs
Post by: Michele on November 16, 2017, 05:23:35 PM
It will vary depending on the insurance carrier but my guess is that it will kick out the entire claim.

But I too am curious as to the purpose.
Title: Re: Sending Dummy CPTs
Post by: rcmbilling123 on November 17, 2017, 01:11:08 PM
It will vary depending on the insurance carrier but my guess is that it will kick out the entire claim.

But I too am curious as to the purpose.


What is the purpose of this?



Long story short, it would allow our auto-coding software to add LT and RT modifiers to lateral imaging CPTs.
Title: Re: Sending Dummy CPTs
Post by: PMRNC on November 17, 2017, 01:58:12 PM
Quote
Long story short, it would allow our auto-coding software to add LT and RT modifiers to lateral imaging CPTs.

I'd be really careful with this ...I'm still not seeing the point to the process of creating made up CPT's.. and I'd be very cautious in doing so.
Title: Re: Sending Dummy CPTs
Post by: Michele on November 17, 2017, 07:24:24 PM
I personally think the dummy CPTs would cause more issues then they would resolve.  I'm not sure what system you use but I would think there would be another way to accomplish this.