recoding by insurance

Situation: MD orders 82565 Creatinine, 82947 Glucose, 84520 BUN, and 80051 Electrolyte Panel. Did NOT order 82310 Calcium, so this is not 80048 Basic Panel.

Insurance recodes claim as 80048 and pays only for 80048, stating they are allowed to recode this per their guidelines, even if not all of the constituent parts of 80048 were performed. Definition of 80048 states it must include all tests. Am I correct in my thinking that insurance is incorrect in telling me it was billed wrong?

re: recoding by insurance

Sending question again. Probably an easy one for youall, but I'm having a bad month.

re: recoding by insurance

In a situation such as this, I reference the carrier's medical payment policy on the issue in question if, they have one available.

re: recoding by insurance

I would appeal it back to the insurance informing them that the 82310 was not performed (if it was indeed not performed). You should provide them with the lab results to provie what tests were indeed performed.

re: recoding by insurance

[Situation: MD orders bmet 82565 Creatinine, 82310 Calcium, 84520 BUN, and 80051 Electrolyte Panel. Did NOT order 82947 Glucose , so this is not 80048 Basic Panel.

Insurance recodes claim as 80048 and pays only for 80048, stating they are allowed to recode this per their guidelines, even if not all of the constituent parts of 80048 were performed. Definition of 80048 states it must include all tests. Am I correct in my thinking that insurance is incorrect in telling me it was billed wrong?]