Wiki 99310 in POS 32... Blue Cross

[enascimento]

Hello,

I have a few claims sitting on my desk denying because they are stating that 99310 is incompatible with POS 32. Our physicians visit patients in the Nursing Home.

Now - BC has paid 99304-99309's, as this this pts had been in the POS for some time. (Nursing Home bills using POS 32 also)

Any insight why BlueCross dislikes 99310 in POS 32?

Thank you!

 

[mitchellde]

It may be the diagnosis. The CPT book description states the patient may be unstable or may have developed a significant new problem. This is a high level of service and perhaps they consider it too high for status quo.