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tci General Surgery Coding Alert - 2005 Issue 10

Reader Questions: You Supply Evidence for Unlisted-Procedure Pay

Question: How do insurers determine reimbursement when I report an unlisted-procedure code? Can our practice do anything to increase or improve our reimbursement chances when reporting these codes?Georgia Subscriber Answer: There's no standard fee for unlisted- procedure codes such as 37799 (Unlisted procedure, vascular surgery). Rather, insurers consider such claims on a case-by-case basis. Therefore, the success of any unlisted-procedure claim depends largely on the documentation you submit with your claim. You should submit full documentation with every unlisted-procedure claim. To improve your reimbursement chances, you should take these two additional steps, whenever possible:1. Include a cover letter...

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