CPT Code Descriptions
Categorized by the following codes 64490,64491, 64493, and 64494
What are Facet Joint Injections?
Defined by the following codes:
PR-1, PR-2, PR-3
Deductible, Co-insurance, and Copay
What website/portal is mostly commonly used for finding out claim status for these payers: BCBS, Aetna, Humana
Availity
This is how bilateral procedures are billed in an ASC.
This is where you look for detailed Medical Necessity Requirements for Medicare.
LCD - Local Determine Coverage Article
These codes are associated with this type of procedure: 45380, 45385, 45381, 45388
Colonoscopy
This is the code for missing authorization
CO-197
After noting an account, this step must be completed before moving to the next account in HST.
Changing the Visit Category
Covered once every 24 months if you’re at high risk.
Colonoscopy
This common EOB denial adjustment code means the cpt code was bundled into another cpt code on the same date of service.
CO-97
When coming across this type of account in your regular work day, you need to skip the account regardless of which center you work on. 2 answers needed.
Zero and Credit Balance
This is the revenue code for billing an implant under an institutional/UB payer.
0278
No more than two sessions will be reimbursed per rolling 12 months.
What is CPT 64633, 64634, 64635, 64636
Radiofrequency Denervation
A mandatory, across-the-board 2% reduction in Medicare payments to providers, required by the Budget Control Act of 2011
Medicare Sequestration
This process must be completed when triggered by the following denial codes
PR-22, PR-31, PR-27, PR-20
Coordination of Benefits
This payer requires an SG modifer as the primary modifer on every line. 2 payers
Department of Labor and Gallagher Bassett
Requires 50% or greater improvement in symptoms to be considered medically necessary
What is Permanent Implantation of Neurostimulator?
This denial code may show up in the EOB, but should not be accepted at 100% accuracy. A call must be made to the insurance.
CO-119 Maximum benefit reached
This process should be done in Waystar when receiving a claim worth more than $99,999.99 for Medicare
Split the Claim
16
This code is not covered when billed with any of the following codes: 29824, 29827, and 29828 due to Medicare NCCI edits.
What is CPT 29822
Limited Debridement of Shoulder