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TIP OF THE WEEK - September 16, 2013

TIP OF THE WEEK - September 16, 2013. A medical provider submits a bill to ACS for payment. ACS pays a portion of the bill but denies a portion. The explanation for the denial was : EOB Code 437 -- PROCEDURE CODE NOT IN EFFECT FOR DATE OF SERVICE. What is the problem?. ANSWER:.

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TIP OF THE WEEK - September 16, 2013

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  1. TIP OF THE WEEK - September 16, 2013 A medical provider submits a bill to ACS for payment. ACS pays a portion of the bill but denies a portion. The explanation for the denial was : EOB Code 437 -- PROCEDURE CODE NOT IN EFFECT FOR DATE OF SERVICE What is the problem?

  2. ANSWER: THE PROBLEM: The EOB code refers to the CPT code used for billing. According to the 2013 CPT book and EncoderPro, CPT 90718 was deleted as a usable CPT code effective January 2013. Note: The bill in question was submitted for a Date of Service in July of 2012. Why was this bill denied? Thanks to Nancy Dobyns at OWCP, the mystery was solved. She checked the OWCP treatment suite viewer, and it said: “ 90718 is end dated as of 06/30/2012 and is not currently available for use.” That’s why the code did not pay. Solution: There are other codes in the 2013 CPT book that may cover the service rendered. The provider should chose the most appropriate code and re-submit the bill. If you have a question or topic for Tip of the Week, contact your District 6 Liaison, Jacksonville, FL

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