March 1999 AAOS Report

Examples of CPT coding mistakes needed

Any experiences that members may have had with insurance companies refusing to recognize CPT modifiers or inappropriately bundling services together is being sought by the Academy. The Academy and American Medical Association have become increasingly concerned with the failure by some insurance companies and managed care plans to follow CPT guidelines. Members are asked to list specific examples (including the name of the payer) where modifiers have not been accepted or where claims-editing software has inappropriately bundled distinct procedures or services. These examples will be used to educate payers about appropriate use of CPT. <


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