Question

Raja is very relieved when her breast biopsy comes back negative; however, she is upset that the insurance company appears to think she already has a history of breast cancer. In looking at her claim form, you see that the coder mistakenly chose a code for history of breast cancer instead of family history of breast cancer. Physical exam code 99396 was submitted on the same claim form. Is this correct? If not, why not, and how should this be handled?

Answer 1

Answer: The physical exam code 99396 is for the age and gender physical exam. The Medicare doesn't pay for this mentioned codes and hence if this code will be mentioned then she will be not get reimbursement.

This error should be fixed as soon as possible. The coder should correct the code, mentioned the reasoning beside the incorrect information and should mentioned the proper code of the diagnosis.