is there a VA Office/Clinic on the island that might be able to help with the codes?
Posted on 04/17/2011 6:19:34 PM PDT by usnavy_cop_retired
I am in the process of filing an appeal on a Tricare claim that failed to pay the proper amount. I am in need of someone with medical billing background to tell me what CPT codes are used for a urine electrophor test and a serum electrophor test. I know that the CPT codes 84165 and 84166 are used but I also have read that there are several other sub procedures that are part of the billing for these test. Some that I have identified are; 86335, 86334, 86320 and 86325, but I am not sure if they are routinely billed with the 84165 and 84166 codes. If anyone can assist me, I would truly be appreciative
CPT codes are treatment codes.
They are what insurance companies use to pay x amount. Just google CPT codes and you will find them listed.
working on it
Might want to talk with whomever did the tests. Government insurance has not paid for “unbundled” billing for some time now. Even though it may be two tests, if they can both be done at the same time then breaking it into two lines/separate codes for billing will likely be denied. Whomever is looking at your appeal will also take the diagnosis code into consideration.
Also, make sure the ICD 9 code is at the highest specificity for your medical documentation
Is that Urine protein electrophoresis ?
Good luck, you’ll need it.
Whether it was an inpatient, outpatient or professional office, or diagnostic lab claim must be known. The pricing and use of bundled codes and/or rolled-up charges depend upon the type of claim.
It’s an out patient lab test. I live in the Philippines and providers here bill on a global billing basis. Most lab test are billed as the normal name of the test since the local providers do not bill by CPT codes, (in fact they don’t know what a CPT code is, thus Tricare is forcing retirees to determine the codes and pricing for our claims or else we don’t get paid).
An example is that a urine culture test is billed in the states using three separate CPT codes for the three separate test done. Unless we identify the three normal co-procedures performed and normally billed for that test, we only get reimbursed for one CPT code, which is about 25% of the actual cost.
is there a VA Office/Clinic on the island that might be able to help with the codes?
outstanding...
CPT codes are just the numbers assigned to the lab tests. Whether or not they are reimbursed by your insurance often depends on how the doctor ordered the tests and the code numbers assigned to the diagnosis. Was the test for a specific ilness/disease or was it a screening test?
Hard to follow so let me give you an example. Let’s say your doctor ordered an xray of your foot but put down neck pain as your diagnosis. Even if the CPT code for the xray was correct -It doesn’t matter - because the diagnosis and the test DON’T MATCH! It won’t get paid by any insurance company. Also some insurances don’t cover all tests. Check with the insurance company and if needed your doctor’s office to fix any discrepancy.
I work in medical coding for a hospital; it’s usually the diagnosis that is the issue that affects reimbursement.
Holy cow! We have an entire section of a mainframe to do that sort of thing.
Hmmmm.....do you need the Tricare allowed amount, Tricare covered amount or the provider billed amount for pricing? They are very different dollar amounts.
I can get CPT4s if you shoot me all the test titles. I don’t code CPT4 myself but I know people who do.
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