Wiki Workman Comp Billing Question

[evillan2015]

I submitted a claim to a Workman's Compensation Carrier as follow:
CPT codes
62365- Removal of subcutaneous reservioir pump, previously implanted for intrathecal or epidural infusion
62362-59 - programmable pump, incluiding preparation of pump, with or without programming
62368-59 -with programming
95991-59 -requiring a skill of a physcian
77003-26 - Fluoroscopic guidane and localization of needle or atheter tip for spine
95972-59- Complex spinal cord, or periphjeral neurostimulator pulse generator/transmitter,w/ntraoperative or subgsequent programming
A4220 - supplies
J2275 - agent

DX Codes:
G56.42
M79.1


all paid but the main procedure 62365, and 62368-59, A4220
and 62362-59 paid @ 50% even though the main procedure was not paid

Please advise as to what I can do for the codes not paid can be reconsidered.

Thank you anyone that can assist. It will be greatly appreciated. Now days WC I believe follow Medicare guidelines not sure.

Please Help

Elizabeth in (it so hot here in San Antonio) coming from a Chicago girl

 

[danskangel313]

A couple of things first...
Am I correct in assuming the services were rendered in San Antonio?
Can I ask who the WC payer is?
And, on the EOB/RA they sent, does it indicate if they accessed any kind of network for discounts or adjustments? (eg, Coventry, First Health). [I know TX is fee schedule, but you never know]

WC is an icky thing to deal with. WC payers aren't included in a lot of rules and regulations that everyone else is since they aren't considered a "health plan."