Device Code Question.

[ms.spoon]

Hello - my orthopedic doctors been performing spine surgeries for some time. Lately, they have been doing a device, which we been billing out as C1821.

 BCBS North Carolina (which is where I am located) is denying for investigational so I called the company, Stalif C & they told me that we should be using C1713 or L8699.

Anyone has any knowledge to share about this? Our charge master lady is saying we cannot use those. I am wondering why because she can't give me a reason. And these is over $10,000 being denied & it ends up being the PT's responsibility on certain cases.

[Michele]

HCPCS Code L8699. L8699 is a valid 2019 HCPCS code for Prosthetic implant, not otherwise specified or just “Prosthetic implant nos” for short, used in Lump sum purchase of DME, prosthetics, orthotics.

HCPCS Code C1713. C1713 is a valid 2019 HCPCS code for Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) or just “Anchor/screw bn/bn,tis/bn” for short, used in Other medical items or services.

HCPCS Code C1821. C1821 is a valid 2019 HCPCS code for Interspinous process distraction device (implantable) or just “Interspinous implant” for short, used in Other medical items or services.

You should be using the one that most accurately describes the equipment.  If the C1821 is still considered investigational by BCBS of NC and the plan doesn't cover investigational devices then there's not much you can do.  But if one of the other codes is accurate then you could use one of them.  Why is the charge master saying you cannot use them?