Author Topic: Can't get the Best Code from Insurance Company  (Read 1218 times)

lisa_jvs

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Can't get the Best Code from Insurance Company
« on: August 25, 2011, 10:57:44 PM »
I am working on a report for a company whose clients have been getting denied or minimal payment for therapeutic laser Tx.  (Codes used:  97039, 97110, and S8948)

I call insurance companies, but because I'm not connected with a physician or facility they won't give me the best code to bill under and reasoning why the others don't work when applicable.

Any suggestions on getting this information?

(I'm not doing the billing.  Again, I'm compiling a report for the company that made the Tx tool, and the physicians/facilities that have purchased it are asking for getting the most $ when billing)

Sriram_Sub

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Re: Can't get the Best Code from Insurance Company
« Reply #1 on: August 26, 2011, 10:24:41 AM »
Hi Lisa,
Would need more clarity on the actual problem faced by the Providers. Can you mention the exact denial(s) they have been receiving for these codes? Also, we need to check if the DX codes are compatible with the Treatment codes. May be we can narrow down the problem if we have these information.
Sriram

lisa_jvs

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Re: Can't get the Best Code from Insurance Company
« Reply #2 on: August 26, 2011, 12:11:52 PM »
Unfortunately, All that you've read is all the detail I have.  Due to the size of the company and the number of its practitioners using their product, information on exact denials, Dx, etc. are innumerable; hence my frustration with the assignment.

The company, which has extremely limited CPT knowledge, only gave me a longer version of what I posted in my original note.

Thanks for the willingness to try and help though.

Michele

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Re: Can't get the Best Code from Insurance Company
« Reply #3 on: August 28, 2011, 06:55:44 AM »
I agree with Sriram, can't really be of any help to you based on that limited info.  Sounds like they want a miracle worker instead of a consultant.  They can't expect you to help them if they can't provide you the info you need to do so.

Good luck!
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DMK

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Re: Can't get the Best Code from Insurance Company
« Reply #4 on: August 29, 2011, 11:28:09 AM »
Therapeutic laser treatment can be / should be billed 97039 with treatment notes attached showing what the "unlisted modality" is.  97039 is a vague code and often requires notes to explain. The CPT book shows to "specify type and time if constant attendance". 

If this is for "cold" laser, it may be disallowed since this therapy is still considered "experimental" with some insurance companies.  The best we were ever able to do was bill it as "infrared" 97026.  The reimbursement isn't much, but it's something.