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Ins says, "Code your nuclear study as routine"

  1. #1
    Default Ins says, "Code your nuclear study as routine"
    Medical Coding Books

    Lately, Iive received 2 calls from patients whom has spoken with their insurance company regarding their high deductible balance after their nuclear study (78465) was performed. They were instructed to contact the doc's ofc and tell us to recode our test as "routine". This made no sense to me as I do not find a nuclear study to be routine. The patient should have a definitive symptom or Dx in order to have the test ordered. My take on it; is that the patient's health benefits do not cover this type of high dollar test.
    Am I wrong? Would someone kindly provide some insight into this matter?
    Thanks in advance for your input!

  2. Default "Routine care"
    I work in a 2 cardiologist office. We do stress echo and nuc stress. We get that comment frequently after patients call their insurance company. The patient will call and say we need to rebill as "routine care." It makes NO sense to us either! There really is not many tests that are routine by a cardiologist! I wouldn't even know how to code it that way?? You are not alone!

  3. Default
    I have had this argument with patients many times. A nuclear stress test is not usually performed for "routine" reasons because the patient has risk factors. Whether those risk factors are chest pain or a famiy history etc really makes no difference. Patients may have better benefits for routine services (less out of pocket cost) but this is not a routine service.

    The patients are asking you to rebill with a diagnosis of V70.0 to enhance their insurance benefits. This is not normally appropriate. In fact, I don't think it is ever appropriate.

    I actually had to go to small claims court in regards to a patient who wouldn't pay his bill because of he wanted it billed as routine. I had to pull the physician out of patient hours to tell the judge personally that it was not a routine service. We prevailed.

  4. Default Routine Care
    We've had a couple people call us too. I did a lot of research and called our provider representative from the insurance company that told the patient this. The member representative was way wrong... Routine Services are procedures or tests that are ordered for a patient without direct relationship to the diagnosis or treatment of a specific symptom, disease or injury.
    A Nuclear Scan is not routine care. A cardiologist will never bill 'routine services'. It's always 'related' to something.
    She even went as far as to make the member services representative call the member back and explain this to them.

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