We are having a Carefirst problem where they reverse the CPT codes and pay the 43239 first, at 100% and the 45378 second, at 50%.
It is also happening when billing (for example) the following:
45385
43249
43239-59
They pay it like this:
43249 100%
45385 50%
43239-59 25%
Now I realize part of this is contractual (the 100-50-25 in particular), but according to Carefirst, they use McKesson software and it is that specific software which is placing the codes in that particular order to pay. It is my belief there is an error in the McKesson software and it is ordering these based on the NON-FACILITY RVU's, even though these procedures are all performed in an ASC setting. If I run a claims check on these codes using a non-facility POS, they come up in the exact order in which Carefirst is paying them.
Does anyone here have any experience with dealing with an incorrect McKesson edit?
Thanks!
-P
It is also happening when billing (for example) the following:
45385
43249
43239-59
They pay it like this:
43249 100%
45385 50%
43239-59 25%
Now I realize part of this is contractual (the 100-50-25 in particular), but according to Carefirst, they use McKesson software and it is that specific software which is placing the codes in that particular order to pay. It is my belief there is an error in the McKesson software and it is ordering these based on the NON-FACILITY RVU's, even though these procedures are all performed in an ASC setting. If I run a claims check on these codes using a non-facility POS, they come up in the exact order in which Carefirst is paying them.
Does anyone here have any experience with dealing with an incorrect McKesson edit?
Thanks!
-P