Author Topic: Questions relating to EAPG/APG  (Read 829 times)

GodBlessNY

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Questions relating to EAPG/APG
« on: October 05, 2016, 09:33:15 PM »
Hello there!
I have a question regarding an EOB I received: we billed for an ER visit plus a simple repair of a wound (CPT code 12001). This bill is being treated as an ambulatory bill. The carrier has bundled the ER visit, which is a flat rate of $101.00 for downstate, into 12001. The bill also had an  X-ray service, which wasn't paid as well. The whole bill is being treated as an ambulatory bill (APC methodology). My question is this: Are simple repairs of wounds (CPT code 12001, 12002) considered ambulatory with the current guidelines or should I appeal this? Thank you!

Bob
« Last Edit: October 05, 2016, 09:40:20 PM by GodBlessNY »

Michele

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Re: Questions relating to EAPG/APG
« Reply #1 on: October 06, 2016, 09:45:50 AM »
Are you billing the professional fees or the facility fees?  If they were professional fees I'm assuming you billed a 9928* with the 12001.  Did the 9928* have a modifier on it to indicate it was separate?  If not then it would be correctly bundled into the 12001.  Let me know if I'm way off on what you are asking.
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GodBlessNY

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Re: Questions relating to EAPG/APG
« Reply #2 on: October 06, 2016, 08:55:58 PM »
Yes, the bills are facility bills. I can see how in some cases, they do bundle 12001 into 9928* (ED) service but I'm wondering why 12001 would be treated as an ambulatory service? It's like the whole facility bill: ER + 12001 + xray are all bundled together and given an APC rate.

Michele

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Re: Questions relating to EAPG/APG
« Reply #3 on: October 07, 2016, 07:13:06 AM »
Is this with one particular insurance carrier?  I don't have experience with this particular scenario but I would start by contacting customer service.  It doesn't seem right.
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