10/23/2019

Denial for CPT 99203-BSNENY

Why did the BSNENY insurance do a take back of payment for this claim denying payment for the 99203 when doing a reversal on the claim 6 months later? How should this have been addressed initially when submitting the initial claim

Payment was retracted by Blue Cross because CPT 28470 has a 90 day global period, and the E&M code was billed with modifier 25 appended. This CPT should have been billed with modifier-57 appended. Additionally, an initial diagnosis is needed-S92.354D should be S92.354A for initial encounter. A corrected claim would need to be submitted with the corrected coding to have payment reissued for the office visit.