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Thread Topic: Third Party Payer Changes Procedures
Topic Originator: JimH
Post Date April 8, 2013 @ 9:58 PM
Third Party Payer Changes Procedures


JimH
April 8, 2013 @ 9:58 PM Reply  |  Email Friend   |  |Print  |  Top

I work with military retirees who are required to do their own coding of their claims in order to get paid. In some instances the providers will file claims. I am wondering if anyone has seen this kind of issue before?

A claim was submitted by a provider for 7 laboratory tests, 84820, 85025, 82565, 82947, 83036, 80061 and 81000. When the claims processor processed the claim and returned an EOB they showed 99499 - 7 Medical Office. I know from research that this code is seldom used and then only when no other E&M code is appropriate and usually when the care provided by a physician or nurse is at a level to low to qualify for any other E&M code.

Is there something that I'm missing here and this is appropriate?



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