Our office has been having a problem (just this year) with Coventry denying some of our non-E/M services. Here's what's going on:
We do nerve conduction studies in our office. These are not face-to-face, or E/M services, but they are being counted as such according to Coventry because, in the CPT book, the decision tree for New vs Established Patients states, "Received ANY professional service from the physician or another physician in group of the same specialty within the last three years?" It doesn't state face-to-face...so, someone at Coventry figured this out and so they have been denying a bunch of our claims this year because sometimes we'll have the patient come in for one of these studies prior to seeing the physician, so we'll code the E/M visit that occurs afterwards as a New Patient visit and they are denying it, stating it should be Established...you get the picture.
So, we tried to argue that the wording in the book was the same as it was last year, but Coventry wouldn't have any of it. Does anyone know of any resource that states anything in print that we could send to them depicting the fact that E/M services have to be face-to-face, etc? We tried to call the AMA but got stuck in a phone loop because we are just billing "civilians." We really need some type of documentation to send with appeals to try and get these paid, because our fear is that since Coventry is trying to pull this BS, who else will follow...Medicare?
Any help or suggestions anyone can give would be very much appreciated. we have a bunch of denials to appeal...
Thanks in advance,
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