Author Topic: Incorrect usage of CPT Codes?  (Read 4805 times)

thatcuteblonde

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Incorrect usage of CPT Codes?
« on: May 07, 2008, 12:44:08 PM »
Here's a difficult one; I work for a financing co and we paid a doctor for numerous charges billed using the CPT code 99080 -"Special Reports such as insurance forms more than the information coveyed in the usual medical communications or standard reporting form." All of the patiens are workers compensation so it didn't appear to be that unusual until I noticed this charge was billed along with every office visit. When I spoke with the person who's responsible for the billing at the doctors office, I asked her what special forms they were completing or what justification she had for billing this charge. She indicated they used this code because they had to pay for the notes from the office visit to be transcribed by a dictation service. I do not think this is appropriate at all, but this woman has stated the insurance company will pay for some of these. If the insurance company does issue payment, it is only because they are not aware of what they are using this code for. I am not sure how to proceed with this, as I do not feel this is correct. From my understanding CPT code 99080 should be used in situations such as completing adoption forms, disability paperwork or an employment physical not to cover things that are an office expense. Any suggestions or feedback?

Thank you!

Michele

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Re: Incorrect usage of CPT Codes?
« Reply #1 on: May 08, 2008, 12:10:38 PM »
Hi,
   I agree with your interpretation also.  There is no insurance rule that states that a Dr must use a dictation service or even that notes must be transcribed.  A Dr. is required to have notes in the patient's file, but the form they choose to use to get them there is up to them.  I believe that the insurance carriers would not reimburse this code if they knew what it was being billed for.  Also, if you look at the description of code 99080 it states " special reports such as insurance forms, more than the information  conveyed in the usual medical communications or standard reporting form."  It sounds to me that the dictation is part of the 'standard reporting form.'

Michele
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Cpatel

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Billing for Special reports
« Reply #2 on: June 19, 2013, 10:43:06 AM »
One of my client wanted to bill 99080 to insurance, but as usual commercial do not pay for 99080. Is any one aware of any replacement code for 99080 that commercial payers will pay?

PMRNC

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Re: Incorrect usage of CPT Codes?
« Reply #3 on: June 19, 2013, 02:35:24 PM »
Quote
Here's a difficult one; I work for a financing co and we paid a doctor for numerous charges billed using the CPT code 99080 -"Special Reports such as insurance forms more than the information coveyed in the usual medical communications or standard reporting form.

This is just small example why I always advise my clients never to do A/R funding/financing. With that said.. I would think you would need to refer to whatever contract you had in place with this office, do financing companies just cut a check w/out reviewing the actual charges? I would think if there were a number of these it would have been caught before purchasing the A/R.  Yeah, i know.. another topic all together, I don't believe in A/R funding at all. Too risky.
Linda Walker
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