William Ivan Posted Fri 30th of May, 2014 11:40:35 AM
We have been receiving denials from blue cross blue shield stating it is not payable per contractual agreement. Are we billing the blood glucose test with an incorrect cpt code? I know we have billed this code and it was paid by Medicare but it seems as though only blue cross blue shield denies the code.
SuperCoder Answered Fri 30th of May, 2014 12:04:46 PM
The definition for CPT code 82962 is (Blood - by glucose monitoring devices cleared by the FDA specifically for home use). There were two reasons 86962 were denied and they were for insufficient documentation and incorrect Type of Bill.
The following methods have and/or could be used to help each and every provider to receive payment correctly. These methods are listed: phone call, letter, face to face meeting with a member of the medical review staff or provider representative and specialty workshops. Only your participation and quality assurance program will effect the appropriate changes to maintain positive results.
William Ivan Posted Fri 30th of May, 2014 12:35:30 PM
So, for a test performed in the office, what code would I use?
SuperCoder Answered Fri 30th of May, 2014 15:47:29 PM
82962 is Not Limited to Home.
You can report the code for use in a physician office lab; the definition doesn't limit you to home use for the test.
William Ivan Posted Sat 31st of May, 2014 09:56:37 AM
So I am sorry but I am confused. BCBS is denying this code stating it is not payable per contractual agreement - What am I missing here. I think I am misunderstanding your first response.
William Ivan Posted Tue 03rd of June, 2014 14:50:45 PM
Can you clarify your initial response. I am confused as why BCBS would be denying the 82962, stating procedure is not covered.
SuperCoder Answered Wed 04th of June, 2014 09:45:15 AM
The code you mention is for a glucose home monitoring device. It is covered by Medicare and paid on the clinical laboratory fee schedule. However, CPT has other codes for blood glucose that might be more appropriate, depending on how the test is performed, such as
82947 Glucose; quantitative, blood (except reagent strip)
82948 Glucose; blood, reagent strip
82945 Glucose, body fluid, other than blood