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EMPIRE--ORTHODICS

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catooch:
Hi,

I work at a chiropractor's office and we have a patient that has Empire BC/BS PPO Plan.  He is covered for orthodics as long as we submit the proper diagnosis codes.  I called them today with the codes--739.3, 739.4, 719.47, 736.79 and they rejected these.  Does anyone know which codes they do approve for orthodics?   Of course they would not tell me which codes they do accept.

Also if I submit these with the code 99212 I think they pay for the exam for this.................

I appreciate your help.

Cathy

Michele:
Hi Cathy,
 
   We have a DC who uses 724.2, 724.3 or 843.0 a lot.  You must have a back diagnosis prime, since the doc is a DC.  You can't use the nonallopathic lesions diagnoses (739.0-739.5) since they don't justify the need for orthotics.  We are billing orthotics for a couple of DC's and the codes above work well.

Good Luck
Michele

catooch:
Thanks Michelle for all your help, it is very useful.............

cathy

catooch:
Hi Michelle,

I used the diagnosis you suggested(724.2, 724.3, 843.0) and they still denied the need for orthodics.
Are there any other ones I can try?
Cathy

Michele:
Wow, those work every time for us.  I would call your provider rep and talk to them about it.  They have to be able to explain to you what the guidelines are for orthotics, what conditions they are covered under.  Maybe it is just a plan exclusion for this particular patient.

Michele

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