ollielooya
True Blue
Followup procedures when E/M claim denied along with Prolonged Service Codes from an 08 claim? AR work reveals that a 99245 was rejected along with an extended service code of 99354. Lengthy review by insurance company said chart notes did not support the total charges for both codes. Upon reviewing the chart notes, I understand why the 99354 was denied, but NOT the 99245 It's clearly an indication of less than stellar documentation. However, (rookie question--How long can I use this excuse? 
), Can we resubmit WITHOUT the prolonged service code and still get paid for the 99245? Doctor did have a long visit with the patient for C&C, but there is no actual documentation of time spent, only the issues discussed. Or do we let it stand and allow it to be written off, and write a note to the doc stating the reason---- that only if he had documented better with face-to-face timeline guidelines as furnished by CPT 2009 Professional Edition -p.26) his E/M visit could have been assigned a Prolonged Service Code? Surely, at least the 99245 visit would be considered, right?
Is there additional information I need to furnish to get comments? ---Suzanne E. Byrum, CPC-A
), Can we resubmit WITHOUT the prolonged service code and still get paid for the 99245? Doctor did have a long visit with the patient for C&C, but there is no actual documentation of time spent, only the issues discussed. Or do we let it stand and allow it to be written off, and write a note to the doc stating the reason---- that only if he had documented better with face-to-face timeline guidelines as furnished by CPT 2009 Professional Edition -p.26) his E/M visit could have been assigned a Prolonged Service Code? Surely, at least the 99245 visit would be considered, right?Is there additional information I need to furnish to get comments? ---Suzanne E. Byrum, CPC-A