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Can you describe a procedure in 80 characters?

Don’t leave loop 2400/SV101-7 blank when you report an unlisted code for a procedure or a drug -- but make sure you squeeze enough detail into the 80-character space. That’s the latest warning from Medicare administrative contractor (MAC) WPS GHA, which has been getting a lot of incomplete and unpayable claims for unlisted or not otherwise classified (NOC) codes.

“WPS GHA has found that a large number of claims for NOC codes are being submitted with missing or inadequate descriptions of the service provided," says WPS' guidance from Jan. 14.

WPS notes that the claim must include enough information to allow a reviewer to determine coverage and how much to pay. When reporting a NOC drug, the practice should include the name, total dosage, strength of dosage if appropriate and the route of administration.

The MAC provides samples of good descriptions, such as “Arthroscopic decompression of the suprascapular nerve" -- as well as descriptions that aren’t good enough, for example, “Biologic Injection.”

Once you submit the claim, keep an eye peeled for additional documentation requests. The MAC may want to see the chart that goes with the claim to determine how much it will pay or if it will pay at all.

Blog Tags: claims processing
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