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Expired E&M codes

M

mracioppi

Contributor
Messages
12
Location
Tuscumbia, AL
I billed a 99397 for a 5/11 visit and the insurance is saying that this code expired 9/31/10. I can't find that anywhere and in my 2011 CPT book, the code is still effective. Am I wrong or is the insurance company? :(
Please help
 
First CPT codes do not "expire" in September. They are updated for Jan 1 and July 1 on a regular basis with others being deleted or implement due to policy decisions mid year. This is a preventive code and pairs with the V70.0 dx code so the question then is does this patient have preventive coverage? or is it possible this is a timing issue and the patient is not eligible due to the timing? But it is an active code.
 
My vote is the insurance company is wrong.. I just used that code earlier today on a physical and my system took it.
A way you might get around it, change the date of the encounter to 9/31/10 and use the 99397, save it. Then go back and change the date to the correct one 5/11 and save it again?? It may work, may not lol.
 
Retired Code

There is nothing wrong with the code - perhaps the company retired it internally. Also, the insurance company could have a problem with their electronic edits. I would definitely follow up with their rep......
 
The patient isn't medicare, his insurance is a state medicaid program. I agree with pwilkie, the code is correct, the insurance rep is wrong. I have contacted the provider rep to take it over the phone reps. Thanks for the input.
 
To me personally, that sounds like a diagnosis issue. ICD-9 codes could "expire" on 9/30 (if they get deleted or changed) Did you verify that it was a CPT issue?
 
mracioppi said:
The patient isn't medicare, his insurance is a state medicaid program. I agree with pwilkie, the code is correct, the insurance rep is wrong. I have contacted the provider rep to take it over the phone reps. Thanks for the input.
Click to expand...

Many state medicaid programs don't cover preventive medicine. So the issue may actually be that it is a non-covered service, not an expired code.
 
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