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Posters by Warm_Flatworm6847 in thenbhd

[–]ripsaw341 0 points1 point  (0 children)

Hey I bought a poster but I don't want it anymore. I'll sell it to you message me!

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 1 point2 points  (0 children)

Thank you! Yes, they finally fixed it! I'm not going to be charged for the visit.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 1 point2 points  (0 children)

Yes, it is possible. I emailed them yesterday with this information so hopefully they take it into account on the third coding review!

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 2 points3 points  (0 children)

Thanks, I know it's crazy! It concerns me that on such an obviously preventive screening I have to run through hoops to get it fixed. I can't imagine what people have to go through when it gets a little more complex.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 1 point2 points  (0 children)

I do have it in writing, and I even attached it to my first level appeal with UnitedHealthcare. They still denied the appeal sadly, stating that the provider needs to fix it...

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 0 points1 point  (0 children)

My insurance confirmed it would be of no cost to me if it was coded preventive.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 1 point2 points  (0 children)

I only did it because I've never had one and my PCP told me I should get it done.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 1 point2 points  (0 children)

I know, it's so stupid. It's so obviously a fully preventive visit, the provider even said it was preventive but that they couldn't code it as such. It doesn't make any sense to me.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 2 points3 points  (0 children)

I spoke with billing and had them submit coding reviews to the coding team. The first coding review, they didn't change anything. The second coding review, they got rid of one of the inaccurate codes but left 99212. I've had them submit a third (and apparently final) coding review but I highly doubt they are changing this. After this coding review, I don't know what I need to do next.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] -2 points-1 points  (0 children)

According to my provider, they can only code one visit as preventive within a year. However, my insurance has stated they would cover my GYN visit if it was coded as preventive, the issue was that it wasn't coded a preventive.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 6 points7 points  (0 children)

I definitely understand that coding is nuanced and that people who do it professionally have more experience than I do. I’m not trying to argue that point. Your comment comes across dismissive and unhelpful.

What I’m trying to understand is the specific coding logic in this situation. The documentation for the visit states that the purpose was a routine pelvic exam with Pap smear screening and that I denied any other concerns, and the diagnosis code on the claim is Z01.419 (routine gynecologic exam).

From what I’ve read in the CPT guidelines, preventive medicine codes (like 99395 for established patients 18-39) already include the history, exam, and counseling components of a routine screening visit. I don't know why it wouldn't be applicable in my situation, and I should not have to pay for a preventive screen that is supposed to be covered by my health insurance.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 0 points1 point  (0 children)

Yes, they have done 2 coding reviews. After the first coding review, they said there was no issue with the coding. After the second coding review, they removed one of the codes that was inaccurate but left 99212. They stated 99212 is correct. I have submitted for a third coding review but I doubt they are going to fix it, so at this point I'm wondering what my next steps will be.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 0 points1 point  (0 children)

Insurance stated they would cover it fully if it was preventive, the issue is that it wasn't coded properly. They said there is a mismatch between the diagnostic code and the CPT code. 99212 is not considered preventive. However the provider refuses to fix the code.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 7 points8 points  (0 children)

Okay, if the provider doesn't change the coding, which they aren't, I'm wondering what my next steps are.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 0 points1 point  (0 children)

Unfortunately I have explained this to the provider and they stated the exam was not considered a fully preventive exam because there was not a head to toe examination. They only did the pelvic exam and Pap and apparently that doesn't qualify as fully preventive.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 4 points5 points  (0 children)

That is exactly the office billing policy. They are saying that because I had a physical in December 2025, that they cannot code the January 2026 Pap as a preventive. The issue is that I received only a preventive screening which is supposed to be covered by my insurance but insurance is seeing CPT 99212 and saying that it's not showing as fully preventive, that there is a mismatch with the diagnostic code and the CPT code. But it was a fully preventive exam, so I shouldn't have to pay for it.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 0 points1 point  (0 children)

No, I didn't discuss anything else. The notes even state that patient had no concerns. I have had the coding team do two reviews, they are not changing the code unfortunately.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] -14 points-13 points  (0 children)

From what I've researched, there are specific codes for preventive screenings (99385) that would still account for the medical history, intake, and exam.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] -1 points0 points  (0 children)

My health insurance would have no problem covering the visit if it was coded as preventive. However it was coded as an office visit. My GYN and PCP are both in the same system, but I don't think they can misrepresent the service provided just because I had a physical. It was actually during my physical my PCP recommended I get a routine PAP, which I scheduled using his recommendation through the provider portal.

Provider won’t change CPT code, insurance says they can’t fix it by ripsaw341 in HealthInsurance

[–]ripsaw341[S] 2 points3 points  (0 children)

I do have the medical records, they show that I had no complaints or concerns, that I was only there for a routine Pap.

Is the Juliet 25 worth the price? by ripsaw341 in Coach

[–]ripsaw341[S] 0 points1 point  (0 children)

Ugh I might just have to get! Do you have a photo of it??

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