Help - physician report

campglo

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Cigna audit. We used H0003 with physician report- Cigna states we should have used G0431 we feel we have used proper code as both are basically the same. Can I get some support as they are requesting a refund unless I can substantiate. The person I used to help me with coding has passed on. thanks
 

mitchellde

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The H0003 is not payable by Medicare and other payers may have the same stance. If it is not in the Cigna fee schedule then it will not be a payable service. Is there a reason to not use the G0431?
 

Walker22

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Cigna audit. We used H0003 with physician report- Cigna states we should have used G0431 we feel we have used proper code as both are basically the same. Can I get some support as they are requesting a refund unless I can substantiate. The person I used to help me with coding has passed on. thanks

Generally speaking the H series of codes are specifically for Medicaid claims. If this was a commercial insurance claim for 2015, it should have been G0431. For 2016 claims, the code changed to G0479.
 

mitchellde

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Generally speaking the H series of codes are specifically for Medicaid claims. If this was a commercial insurance claim for 2015, it should have been G0431. For 2016 claims, the code changed to G0479.

When I run the H codes thru the fee schedule they all state non payable by Medicare. Sorry yes the G0431 was deleted Dec 31, 2015.
 

campglo

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Generally speaking the H series of codes are specifically for Medicaid claims. If thi

A coder recommended this code as it stated 23 units, we do not bill Medicare or Medicaid. If it is a code just for Medicaid that means it cannot be used for commercial carriers? As you can see I am new at this. G0431 you only bill 1 unit-
Cigna now is refusing to pay or wants refunds and is paying at the new 2015 rates instead of the 2011 guidelines and they are only paying 1 unit of the G0431 at $69.00 and deny if you bill 23 units. Can someone help me?
 

Walker22

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When I run the H codes thru the fee schedule they all state non payable by Medicare. Sorry yes the G0431 was deleted Dec 31, 2015.

Yes, you are correct, they are non-payable by MediCARE. I was referencing the wording at the beginning of the H codes section of the HCPCS book where it states H codes are used for MediCAID. :)
 

Walker22

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A coder recommended this code as it stated 23 units, we do not bill Medicare or Medicaid. If it is a code just for Medicaid that means it cannot be used for commercial carriers? As you can see I am new at this. G0431 you only bill 1 unit-
Cigna now is refusing to pay or wants refunds and is paying at the new 2015 rates instead of the 2011 guidelines and they are only paying 1 unit of the G0431 at $69.00 and deny if you bill 23 units. Can someone help me?

G0431 should be billed 1 unit per date of service. This one unit covers all the presumptive tests done during that encounter. Does that answer your question?
 

avon4117

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just refund cigna for the incorrect billed charges and then do a massive billing for all the correct codes
 
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