Emergency Ultrasound Section Forum
Coding and Reimbursement
Anthem Reimbursement issues
Anthem recently started denying the bulk of US exams performed by emergency physicians. See attached Policy. I have discussed this with the their local rep but have not made any progress. Has anyone else had Anthem specific issues or any suggestions to combat this? I have included my latest correspondence with anthem below.
St Vincent Emergency Physicians, US Director
Here is a summary of their policy, it was too large to attach, I am including only the relevant parts because it refers to many non-US procedures as well.
other procedure, service, or supply.
Coding Section 1: Services and supplies not
eligible for separate reimbursement.
interpretation of a radiology test when performed with an ER or inpatient E/M
35. ultrasonic guidance for needle placement with
CPT parenthetical identified procedures (not necessarily new)
19. 700XX-788XX, G01XX-G03XX, S8035-S8092, and S9024 (these
code ranges include applicable radiology
interpretation codes as well as radiology
codes which modifier 26 would be added to identify the professional component
only) reported with 99281-99285 and/or 99221-99233
reported with CPT codes listed in the CPT parenthetical statement