CPT/G-code Issue


Question: We have one patient/claim with two or more procedure codes all with a 360 revenue code. Our procedure charges are bundled into one dollar amount. Our three CPT codes are: 64483, 64484, G0260. We've tried putting -0- dollar amount on the subsequent lines with the appropriate second and third CPT code. We've tried putting $1.00 on the dollar amount with the second and third CPT codes. And, we've tried putting -0- dollar amount on the subsequent procedures with a 51 modifier on the CPT codes. Our FI is WPS, the error reads "Charges may only be entered once for each ASC accommodation revenue code for HCPCS in the ASC range". How can we get our claims paid?

Answer: Your problem is the G code versus the regular CPT codes. In essence, the codes are exactly the same when you read the manuals, so Medicare wants one or the other, since, if you bill 64484, you have to bill 64483 along with it. (read the description for 64479 up to the semicolon, then read the description for G0260, and you'll see they're virtually the same). So, the recommendation would be to bill one or the other, depending on your FI.

It's possible that your medical records department will believe that it's not coding fully by not including both the G codes and the regular procedure codes. Many hospitals have computer systems that will put the correct code on a claim based on insurance type, which eliminates this problem. If it doesn't, it will be up to the billing department to know the rules of a particular insurance carrier to get a claim paid. It is not considered fraudulent to remove one code or the other if the codes mean the same exact thing.