How to put cpt4 codes in a specific order for insurance claims

Management and Administration
#1

We get rejections from the insurance companies some times because the cpt4 codes in the claim, aren’t in the order the insurance companies want them.

We put the codes in the feesheet in the order that they need to be. And most times that is the order that they show up in the claims. But sometimes they don’t show up in that order.

Is there a way to force the first code in the feesheet to be the first code in the claim. And actually i think they only care about the order of the first 4 codes. So maybe is there a way to force the first 4 codes in the feesheet to show up in that order in the 837? file that gets uploaded to the clearinghouse?

#2

@bearzillasquatch
Are they talking about the list of codes in a claim must be in the right order? Or the CLAIMS need to be in a certain order?
Also, has the Insurance Co told you what order they want?

Are you directly billing the Ins cos, or sending them to a clearinghouse for submission? Massaging the claim content to suit a specific ins co is the sort of thing a clearinghouse would do.

Finally, I’m not totally certain this is true in all cases but I looked in a couple claims I have sitting around my demo system, It appears that the codes appear in the claim file, in the same order that they are entered on the fee sheet. If you know what order they are supposed to be in, you could try having your providers enter them in that order.

And it’d be cool if you posted here the results of that experiment!

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#3

@htuck the order issue is that if the patient has an office visit and has lab work done, the insurance will reject the claim if the lab work is the first cpt4 code. I think it’s medicare and some of the medicare related ins that doing it.

you could try having your providers enter them in that order.

Getting a provider to do something a specific way is like trying to herd cats. I’ll see what I can do and let you know how it turns out.

#4

I get it completely that it can be difficult to get providers to do things differently than how they want to do it.

Do you have particular types of visits pre-coded to save time, as described here:
HOWTO:Add_Custom_Service_Codes_To_The_Fee_Sheet-_Updated

If so you could pre-code the custom service code to be the treatment, then they would add labs after that, if they’re ordered.
Good luck!

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#5

HOWTO:Add_Custom_Service_Codes_To_The_Fee_Sheet-_Updated

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#6

Harley, We have some of those set up. They also forward codes from previous visits through the “review” button on the fee sheet. I have it intentionally set up so that the lab cpt4 doesn’t forward through the review button. But none the less, someone finds a way to get them out of order. I guess i’ll have to find out which provider(s) is causing the problem and put them in the “box of shame” for day or two until they realize the proper way to do things.

#7

Hi DC-
Well, it sounds like you’re doing everything you can, but sometimes it comes down to that, eh?
Your remark reminded me of the movie, ‘Up’. It’s a real hoot if you’re into that sort of thing.
image

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