- Nunica, MI
- Best answers
I have in the past been denied a new patient visit with BCBSM for billing a new patient visit after the reading of a PFT done at the hospital. I appealed it and they paid it. But now Priority Health is doing the same thing. This is not right and should not be allowed for an established patient billing. The work that goes into a new patient visit needs to be defended by us as Coders/Billers. There is no way they can bundle or whatever they are doing to say this is okay for the insurance companies to take this revenue from our providers. Our providers that provide the service of interpretation of these studies need to be compensated appropriately they have no idea they will get a consult out of the interpretation of those tests they read. The patient I am currently appealing had simple spirometry 94010 read at the hospital and was consulted for a sleep study. This is not right in any way shape or form and in my opinion needs to be fought and the more that fight the better the chance of this practice being taken away from the insurance company. Has anyone else appealed the insurance for proper payment of the new patient visit?