tci Part B Insider - 2015 Issue 8

Reader Question: Fight Back on 'Separate Dx' Demands

Question: One of our payers is taking back payment for 99291 and 99292, stating their reason is because we only billed one ICD9 code 434.91 (Cerebral artery occlusion unspecified with cerebral infarction). Where in the CPT® book can I find information to dispute this reasoning? The original bill included codes 99291, 99292, 31500 (Intubation, endotracheal, emergency procedure), and 93010-59 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only - Distinct procedural service). Answer: The CPT® book actually says, on page 7 of the 2015 edition, a separate diagnosis for an E/M and a procedure on...

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