Cigna company "covers only up to 5 pathogens for respiratory panel"
Provider billed 87798- Bordetella, 87631 3-5 pathogens, 87581- Pneumo, 87486 - Pneumo and 87635 - Covid Sars
We are being advised to bill 87631 only as that is correct according to Payer Reimbursement Policy
I do feel like it should be billed with all codes rendered instead of billing with 87631 to adjust coding to payer payment policy.
When they say no more than 5 pathogens are being covered, I think they are referring to 87631 3-5 pathogens (covered) more than 5 pathogens (87633) not covered. Do they actually refer to 87798, 87581, 87486, 87635 as rest of the pathogens so only 87631 is being covered and we cannot get paid if we bill differently?
Provider billed 87798- Bordetella, 87631 3-5 pathogens, 87581- Pneumo, 87486 - Pneumo and 87635 - Covid Sars
We are being advised to bill 87631 only as that is correct according to Payer Reimbursement Policy
I do feel like it should be billed with all codes rendered instead of billing with 87631 to adjust coding to payer payment policy.
When they say no more than 5 pathogens are being covered, I think they are referring to 87631 3-5 pathogens (covered) more than 5 pathogens (87633) not covered. Do they actually refer to 87798, 87581, 87486, 87635 as rest of the pathogens so only 87631 is being covered and we cannot get paid if we bill differently?