Wiki Billing insurance for cosmetic laser CO2 scar revision so PT can claim accident ins.

[JesseL]

So I have a situation here where that patient has been paying cash for her Co2 laser scar revision on her face. She was attacked by someone hence the reason for this. She paid cash for these treatments and then tried to claim accident insurance for these on her own to get reimbursement for the cash payments. She's stating her accident insurance is requesting us to file a claim to her health insurance first to have the claims denied in order for her to claim money back from her accident insurance.

How do I file the claim in this situation?

Thanks

 

[mitchellde]

You would use the scar dx code with the late effect code possibly a 906.0 code along with the late effect of assault E969. This will tell the payer that this was all due to an assault. Also the patient is probably eligible for victims assistance if a police report was filed. By submitting this to the commercial payer, the payer usually will fill this paper work out and send it back to you for a signature which you then submit to the state. However if no police report was filed there will be no assist from this fund.

 

[JesseL]

DO I use cpt 96999? SHe has Fidelis Medicaid.. But she paid for these up front already.. does she have to sign a form that she's aware she's financially responsible due to it being cosmetic if the insurance denies the claim? Like something similar to a ABN? We're not expecting to get paid by her medicaid health insurance. We're just doing it on her behalf so she can claim accidental insurance on her own. And don't want fidelis to accuse us of double dipping or something.