Forum - Questions & Answers

Dec 29th, 2014 - LBAROGIANIS 250 

61500 and 61782

Per Humana is denying claim stating that CPT® 61500 is not considered a primary procecure code.

Can anyone explain this to me? They do not list any primary procedure codes in the CPT® book like they do with other add on codes.

Thanks in advanced!

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Dec 29th, 2014 -

re: 61500 AND 61782

I think the reason its getting denied is that it is not the primary code for the add on code that you are using fo 61782, as that code comes under the subsection of codes for stereotaxis. from my teachings as a coder, add on codes are suppose to be used in the same sub-sections as the primary code that they come under....(just a thought) but if you read the codes under that sub-section for stereotaxis 61720-61791 they seem to follow the procedures that are being performed for that sub-section of codes.

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Dec 31st, 2014 - LBAROGIANIS 250 

re: 61500 AND 61782

Thank you for the input. But I did some research and found out that most payers, including Medicare in my system paid on both CPT® codes 61500 and 61782. It's just Humana is not paying probably due to their own policy. But since Medicaid and Medicare are paying, there should be no reason they shouldn't also. I wish that I had more material to present for an appeal.

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Dec 31st, 2014 - ch76606 123 

re: 61500 AND 61782

61500 is listed as one of the Primary Procedures for 61782.

Per Encoder Pro:

"In those instances where national sources do not provide definitive, uniform information, Optum conducts research evaluating those procedures that may be an associated primary procedure(s) for the add-on code. This research includes AMA, CPT®, CMS, and national specialty society guidelines and medical literature. In some cases consultation with a national specialty is performed in order to interpret unique relationship."

I hope this helps.

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