Good Morning! Please I need assistance, advise or leads to where details of these CPT descriptions can be found.
The physician performed each of the services up to 3 times per code on same day. Both codes are used on different days, although 43256 x3 one day & 43247 x3 another day. The codes originally paid contracted rate for 1 service & others denied as duplicate. Sent dispute w/documentation to no avail, it was denied again!
On 4/21/09 Dr performed & billed 43256 -22, unpaid-denied as duplicate, 43256 -59-22 paid contracted rate, & 43256 -59-22 unpaid-denied as duplicate. On 5/5/09, Dr performed & billed necessary procedures, which included 43256 -22, unpaid-denied as duplicate, 43256 -59-22 paid contracted rate, & 43256 -59-22 unpaid-denied as duplicate, exactly as they paid 1st claim. Our pt was critical care/coma on 6/3/09 performed 43247 -22 denied as duplicate charge, 43247 -59 -22 paid contracted rate, 43247 -59 -22 denied as duplicate charge, & 43236 -59 -22 paid contracted fee.
The descriptions I have do not specify &/or not clear enough to determine if cpts are used for one or multiple placements/removals. My opinion would be that additional time, skill and work was done by the physician. Therefore additional reimbursement is due. Physician performed multiple services w/same cpt code. Again placements &/or removals were in different locations, work, time, technique & skill and Dr. Should Be Reimbursed Additional money for his service. I stated the above & more in the dispute letter.
Are the codes to be reimbursed for one & the same allowed for multiple procedures? Thanks for any insight, documentation, assistance, &/or solutions to this problem is GREATLY APPRECIATED! So
Have a wonderful weekend!
The physician performed each of the services up to 3 times per code on same day. Both codes are used on different days, although 43256 x3 one day & 43247 x3 another day. The codes originally paid contracted rate for 1 service & others denied as duplicate. Sent dispute w/documentation to no avail, it was denied again!
On 4/21/09 Dr performed & billed 43256 -22, unpaid-denied as duplicate, 43256 -59-22 paid contracted rate, & 43256 -59-22 unpaid-denied as duplicate. On 5/5/09, Dr performed & billed necessary procedures, which included 43256 -22, unpaid-denied as duplicate, 43256 -59-22 paid contracted rate, & 43256 -59-22 unpaid-denied as duplicate, exactly as they paid 1st claim. Our pt was critical care/coma on 6/3/09 performed 43247 -22 denied as duplicate charge, 43247 -59 -22 paid contracted rate, 43247 -59 -22 denied as duplicate charge, & 43236 -59 -22 paid contracted fee.
The descriptions I have do not specify &/or not clear enough to determine if cpts are used for one or multiple placements/removals. My opinion would be that additional time, skill and work was done by the physician. Therefore additional reimbursement is due. Physician performed multiple services w/same cpt code. Again placements &/or removals were in different locations, work, time, technique & skill and Dr. Should Be Reimbursed Additional money for his service. I stated the above & more in the dispute letter.
Are the codes to be reimbursed for one & the same allowed for multiple procedures? Thanks for any insight, documentation, assistance, &/or solutions to this problem is GREATLY APPRECIATED! So
Have a wonderful weekend!
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