Forum - Questions & Answers

Oct 27th, 2011 - padi1coder 10 

Workers' Comp denial

I just recieved an denial on CPT: 99212 stating this is a non-covered charge? asked since when and why and of course got an answering machine. Anyone?

Oct 27th, 2011 - Codapedia Editor 1,399 

re: Workers' Comp denial

I can't imagine. What diagnosis code did you use?

Oct 27th, 2011 -

re: Workers' Comp denial

I know- they know that no doctor in their right mind would charge only a 99212 on a workmans comp patient. The counseling and coordination with the insurer always gets these to 99213 at least. A 99212 is a mole check - you dont even get to touch the patient.

Oct 28th, 2011 - padi1coder 10 

re: Workers' Comp denial

724.4 and 722.10, patient was scheduled for surgery in Jan. but there was a dispute and settled....so this was a followup visit to move foward with surgery. The rep I spoke to didn't say it was diagnosis related it was that 99212 is non-covered charge...basically repeating what the EOB states.

Oct 28th, 2011 -

re: Workers' Comp denial

It is unusual for a work comp visit to only be a level 2, but it can happen. If you're sure it's related to the work comp injury, I would appeal with office notes.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association