Billing > Billing
CO-45 denial - getting paid nothing
Merry:
<<Codingline Response: On the issue of the payer denying your office "procedure", CPT is divided into sections: E/M, Surgery, Pathology and Laboratory, Medicine, etc. The injection you are referring to "resides" under "Surgery" (along with cutting toenails and applying a cast). So, if this patient's insurance plan benefit structure language excludes ALL in-office surgery [coding] from reimbursement, then the insurance company's denial of your claim is correct, and you may only be left with charging the patient.>>
So correct..surgery is considered in CPT language from codes that are 10000 to 69999. Even though it was an injection, surgery does not always constitute an open incision or what people not in this industry would consider surgery. You must follow the CPT guidelines.
Since so much podiatric surgery is performed in office, it would be prudent for someone to check the insurance coverage before the procedure is performed.
PMRNC:
Does this maybe help?
CPT Code Clarification for Treatment of Interdigital Neuroma
The American Medical Association (AMA) included two additional codes (64632 and 64455) for treating interdigital neuromas (e.g. Morton’s Neuroma) in the CPT® 2009 Standard Edition (CPT/Current Procedural Terminology) codebook.
Code 64632 (destruction by neurolytic agent; plantar common digital nerve) should be used when a qualified provider injects a neurolytic agent into an interdigital neuroma.
Code 64455 (injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) should be used when an injection of an anesthetic agent and/or steroid is used to treat an interdigital neuroma.
Physicians should no longer use CPT code 64640 (destruction by neurolytic agent; other peripheral nerve or branch) to describe the treatment of interdigital neuroma, as the CPT codes distinctly clarify which nerve is being treated.
Note: CPT codes 64632 and 64455 are limited to once per foot, per visit, regardless of the number of injections used.
http://blueline.staywellsolutionsonline.com/Past/Winter2010/22,Wi10BC2
RichardP:
Linda - that wording is at the first link in my [second] post above. Maybe you were just making it more visible?
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