kandigrl79
Guru
Has anyone been experiencing the above? I've noticed here lately, that "we" bill out one thing, and then the insurance company will change our CPT codes and pay on what they've changed. For example: the surgeon performed an injection at two separate tendon sites so, we billed: 20550 and 20550 -59. The insurance company involved denied those two codes and changed it to 20550 -50 (one claim line) and paid that at a extremely reduced rate. Not to mention the fact that they manipulated the fee amount! This is not the first time I've seen this, and I am seeing it more and more. I was always under the impression that the payers SHOULD NOT be changing CPT codes, specifically since they don't always have the operative report. I always thought that if the payer does not agree with our codes, they should deny those codes and it will be up to the provider to either appeal (at which point we will send the operative report) or send a corrected claim. Any thoughts????