Sample Appeal Letter for Bundling CPR (CPT code 92950) with ED E&M Services (CPT codes 99281 - 99285)

Date


Attn:
Provider Appeals Department
Address
City, State, ZIP Code

Re: Claim adjudication, bundling of CPR (CPT code 99250) with ED E&M services (CPT codes 99281-99285)

 

Health Plan ID Number: Group Number:
Insured/Plan Member: Patient Name:
Claim Number: Claim Date:

Dear Sir/Madam:

The following information is being provided to clarify our use of Emergency Department Evaluation and Management Services (CPT codes 99281 - 99285) with Cardiopulmonary Resuscitation (CPT code 92950).

CPT® is the designated code set determined by HIPAA.  CPT® states "Any specifically identifiable procedure (i.e., identified with a specific CPT code) performed on or subsequent to the date of initial or subsequent E/M services should be reported separately. Accordingly, when CPR is provided in addition to an ED E&M service, CPR (CPT code 99250) is to be billed and reimbursed separately from the ED E&M Service (CPT codes 99281-99285). The performance of the CPR service and ED E&M service are clearly documented in the patient chart and both should be recognized by [health plan] and eligible for payment.

Based on the circumstances of this case, we request that the CPR service be considered for separate reimbursement and not bundled under payment for the ED E&M service.

Please forward this information to your medical review staff to prevent this error from becoming an ongoing problem.

Thank you for your consideration. Please contact [staff name] at [telephone number] in our office should you have any questions regarding this claim.

Sincerely,


[Physician Name]

 

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