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