Q&A: Claims rejected for retinal prosthesis

Q: We have started receiving rejections for claims with HCPCS code C1842 (retinal prosthesis, includes all internal and external components, add-on code to C1841). We provide the service with the retinal implant and are confused why it's getting rejected.

A: You don’t mention whether you are performing this procedure in an ambulatory surgery center (ASC) or a hospital outpatient surgery department. HCPCS code C1842 is an add-on code for the retinal implant as noted in the description and is intended for use by ASCs only. CMS created this HCPCS code because of claims processing restrictions related to the dollar amount that can be reported on an individual line item on an ASC claim. While CMS did assign this code to status indicator N (no additional payment, payment included in line items with APCs for incidental service) under the OPPS, this code is not applicable for hospital claims.

Beginning with the April update, the status indicator for C1842 has been changed to E (services not paid, non-allowed item or service)to prevent reporting of this code on hospital claims. You will want to be sure that your chargemaster contains the correct code for reporting the device. 

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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