Wiki Insurance denied 2023 Code

[RaveenaS]

Pinnacol Insurance is denying a 2023 Hernia repair code, A/R reached out and was told that they are behind and are still using 2022 codes for 2023 services. Is that allowed by insurance to not follow the current year guidelines of reporting/coding? Is there any resources available that can help appeal their denial, stating that they need to process for the correct codes for the correct year?

 

[sls314]

Pinnacol Insurance is denying a 2023 Hernia repair code, A/R reached out and was told that they are behind and are still using 2022 codes for 2023 services. Is that allowed by insurance to not follow the current year guidelines of reporting/coding? Is there any resources available that can help appeal their denial, stating that they need to process for the correct codes for the correct year?

That's Workers Compensation, correct?

In my past life working in contracting/contract analysis across multiple states, I've found that sometimes workers compensation and state medicaids remain on previous code years.

If you have a contract with that payor, I'd review it to see what it says about when/if they'll update their fee schedule to new code sets each year.