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Practice Management Alert

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Denials Based on Old CPT Codes

Published on Mon Jan 19, 2009

Question: Our practice is having trouble billing the new codes for 2009, in particular CPT 96372 in place of 90772. We have had two insurance companies tell us that they did not know about the new code, and now those charges are being denied. What should we do? Illinois Subscriber Answer: You should appeal these denials. Unfortunately, some private insurance companies do not update their systems with the updated CPT Codes by January 1. This, of course, results in inappropriate denials. According to the Health Insurance Portability and Accountability Act (HIPAA), payers can only use one set of transaction codes. As of Jan. 1, 2009 that set should be the CPT 2009 set. Your payer needs to be paying or denying your based on the current codeset. Reporting the injection administration with the 2008 version 90772 should trigger an invalid code rejection, but 96372 (Therapeutic, prophylactic, or diagnostic injection [specify [...]
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