Wiki Question regarding rebilling proc 99243 Workers comp

[Jessicat125]

Hello,
I have an account for workers comp I billed procedure 99243 was for a surgical clearance consultation visit. I received an EOB denial recently stating the procedure 99243 is denying stating an initial visit was billed on a subsequent date of service. Resubmit with an appropriate code. Now the patient was last seen at our office within the 3 years so per the insurance rep this is the reason the charge is denying so a new code needs to be billed. Now my question is do I just rebill with the correct E/M code and resubmit a corrected claim or should I submit an appeal with the 99243 because that is the correct way the claim should be billed with the surgical clearance diagnosis.

-Thank you

 

[teresabug]

First, I would clarify if the work comp carrier in your state even accepts this consult code to begin with. Most have done away with paying 99241-99245 codes as of 2010. (Thank Medicare/CMS for that..)
Some carriers do not pay attention the doctors' specialty on the claim you submit and will sometimes deny the claim for that reason. I would contact the carrier and status the claim and make their they are aware of your dr's speciality because potentially another dr in another specialty saw this patient on the same date of service and that could be why your claim was denied.

 

[teresabug]

one thing I forgot to mention is that all of the dr's in your office I'm sure are the same specialty, working under a group NPI and bill under the same tax ID # so if any of the other dr's there saw this patient in the last three years then yes, the patient is established and not new.