Coding, Classification & Reimbursement

Medicare ER CPT 12002 with Revenue Code 981 returned to provider

  • 1.  Medicare ER CPT 12002 with Revenue Code 981 returned to provider

    Posted 6 days ago
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    ER CPT Code 12002 with Revenue Code 981 continues to be returned to provider by Medicare Administrative Contractor

    I need assistance with this coding and billing scenario please as we continue to have Medicare emergency room claims returned to provider stating that for bill type 85X we cannot code CPT 12002 with revenue code 981. I called our Medicare Administrative Contractor today and basically they were only able to read to me what was already viewable to our billing staff as part of their billing routines through their clearinghouse.

    The verbiage from their billing clearinghouse print terminal is as follows:

    "FOR 85X TYPE OF BILL CLAIMS, THE CPT/HCPCS CODE BILLED AS A PROFESSIONAL SERVICES IS NOT REIMBURSED AS A PHYSICIAN SERVICE. CORRECT THE REVENUE CODE AND/OR THE CPT/HCPCS AND RESUBMIT."

    The reason code is 36602.  

    The ER has billed for CPT CODE 12002 (Rev Code 450) as well as E&M code 99283 with modifier 25 appended (Rev Code 450 too). The physician who has assigned his Method II billing rights to our Critical Access Hospital is also submitting CPT CODE 12002 under revenue code 981 and this is what is being returned to provider with reasons quoted above.

    This patient came to ER due to laceration of second and fifth fingers of left hand totaling 3 centimeters in length.

    Modifier 25 cannot be appended to the CPT CODE 12002 with Revenue Code 981 as it, obviously, is not an E & M code.

    What do we need to do differently to submit this claim correctly?  We have had four similar claims returned to provider since the beginning of the year.

    Respectfully,



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    Angela Scott
    Dir. HIM / CM Depts., Privacy / Compliance Officer
    Russell County Hospital
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