Medical Billing Forum

Coding => Coding => Topic started by: dfranklin on September 10, 2010, 12:15:32 AM

Title: 98943 & UPMC (did something change)??
Post by: dfranklin on September 10, 2010, 12:15:32 AM
OK..here is one I haven't ran into...I have billed 98943 for my chiro for many insurances just fine and in fact for this carrier in question I have billed 9843 for them as well (which is UPMC).  Now it was denied with this ""Not otherwise classified" or "unlisted" procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service"  Did something change?  98943 is a specifc procedure code I thought...any suggestions?

Thanks!!
Don
Title: Re: 98943 & UPMC (did something change)??
Post by: DMK on September 10, 2010, 10:32:43 AM
98943 is an extremity adjustment.  As long as there is an extremity diagnosis it should be payable, UNLESS only SPINAL adjustments are covered.  I would call the insurance company and verify that the code was typed in correctly.  GIGO!
Title: Re: 98943 & UPMC (did something change)??
Post by: dfranklin on September 10, 2010, 05:18:52 PM
Thanks!!!! I will definitely have to call them.  739.7 was used as the extremity code.  So maybe it is just not a covered benefit for this patient or someone there is entering the code incorrectly as you mentioned.  Thanks for your help.
Don