Celesta Posted Fri 08th of July, 2011 19:53:53 PM
I am not a physician or work in a physician's office. I am just an ordinary housewife who had some coughing up blood which resulted in a bevy of procedures- one of which was a pulmonary arteriogram which was deemed to be not "medically necessary". The bill for it was 63,927.96 which was more than two hospital stays and lots of other imaging procedures. My insurance company is no help- all they will say is that it was determined to be not "medically necessary"- they will not tell me why. Anyway, I think that the reason is that it was way miscoded. The insurance company audited the claim. My feeling is that they have lots of expertise available to them and I have no one. I would like to have someone who knows something about coding to help me figure this out.
SuperCoder Answered Mon 11th of July, 2011 13:37:36 PM
Sorry! for my delayed reply.
I understand the criticality of your problem, and I will do my best to help you out. For this, I need some info.
1. Is it a Physician's office or Hospital?
2. Are there any other procedures performed along with this procedure by the same physician/in the same hospital?
3. Billed by the Physician/Hospital?
4. Any other recent radiological procedures performed by the same physician/hospital?
5. Your Primary Insurance ?