Hi, not sure if I posted here before, brief history, my husband Pat needs ADR, been researching and waiting for it for about 1 1/2. We have workman's comp and BCBS Federal. Both have been contacted, both say they do not have billing code 0091T in their computer system, thereby not being able to pay it. The kicker is, our doctor's office requested surgery early January under the old code(fusion code plus another non-specific code). Workman's comp AGREED to pay for that, but by the time they approved it (early April) the nurse at the doctor's office said, "ADR has a new code assigned, we have to use that one", resubmitting the request. Neither insurance has this code in their system. Well, looking at the AMA website, I find that code 0091T was "Released Jan 1 2005, Implemented July 1 2005" My thinking is that insurances probably won't update their codes until July?? Here is what the AMA website says:
Concurrent with the development of CPT-5, the CPT Editorial Panel has approved the "early release" of the new CPT Category III codes. All changes provided as an "early release" of Category III codes is not intended to take effect until the implementation date. To assist users in reporting the most recently approved Category III codes, the AMA�s CPT web site will feature updates of the CPT Editorial Panel actions and early release of the Category III codes in July and January in a given CPT cycle. These dates for early release correspond with the quarterly CPT Editorial Panel meetings for each CPT cycle (May, August, November, and February).
Does anyone else understand this to mean that the doctor's office/hospital should be able to use the old coding until July??? This is driving me nuts, why else would there be an "release" date and an "implementation" date?? I plan to call other doctor's offices on Monday to see how they are doing this.
thanks for any help,
Robin
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