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Expired E&M codes

  1. #1
    Default Expired E&M codes
    Medical Coding Books
    I billed a 99397 for a 5/11 visit and the insurance is saying that this code expired 9/31/10. I can't find that anywhere and in my 2011 CPT book, the code is still effective. Am I wrong or is the insurance company?
    Please help

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    First CPT codes do not "expire" in September. They are updated for Jan 1 and July 1 on a regular basis with others being deleted or implement due to policy decisions mid year. This is a preventive code and pairs with the V70.0 dx code so the question then is does this patient have preventive coverage? or is it possible this is a timing issue and the patient is not eligible due to the timing? But it is an active code.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    My vote is the insurance company is wrong.. I just used that code earlier today on a physical and my system took it.
    A way you might get around it, change the date of the encounter to 9/31/10 and use the 99397, save it. Then go back and change the date to the correct one 5/11 and save it again?? It may work, may not lol.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    Ummmm there are only 30 days in September......

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    Is the pt covered by Medicare? They will not pay for a preventive code.

  6. Default
    Is this patient covered by Medicare?

  7. #7
    Location
    Albany, NY
    Posts
    15
    Default Retired Code
    There is nothing wrong with the code - perhaps the company retired it internally. Also, the insurance company could have a problem with their electronic edits. I would definitely follow up with their rep......

  8. #8
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    The patient isn't medicare, his insurance is a state medicaid program. I agree with pwilkie, the code is correct, the insurance rep is wrong. I have contacted the provider rep to take it over the phone reps. Thanks for the input.

  9. #9
    Default
    To me personally, that sounds like a diagnosis issue. ICD-9 codes could "expire" on 9/30 (if they get deleted or changed) Did you verify that it was a CPT issue?
    Mandy Flagg, CPC, CEMC
    Compliance Auditor

  10. #10
    Location
    Tacoma, WA
    Posts
    1,087
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    Quote Originally Posted by mracioppi View Post
    The patient isn't medicare, his insurance is a state medicaid program. I agree with pwilkie, the code is correct, the insurance rep is wrong. I have contacted the provider rep to take it over the phone reps. Thanks for the input.
    Many state medicaid programs don't cover preventive medicine. So the issue may actually be that it is a non-covered service, not an expired code.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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