Igenex insurance reimbursement

[GraceUnderPressure]

HELP! I'm trying to get reimbursed by UHC for our Lyme & Co-infections panels. UHC says there must be a diagnosis code and a procedure code on each bill.

 

On the Lyme Panel, Igenex put a diagnosis code of 300.3 for all 5 tests, but no procedure code. (And am I going to have a problem with all 5 tests having the same dx code? ie. they'll tell me some are duplicates or something?)

 

And for the co-infections, Igenex didn't give me anything at all. (Or do the CPT codes count for anything?)

 

Can someone who has done this before share the diagnosis & procedure codes with me so I don't have to try to chase them down?

 

~Grace (very much under pressure this morning)

[NancyD]

Hi Grace,

 

It all depends what code your physician used on your original form. For diagnostic code, my DD's doctor used 279.4 and for my test my doctor (different doctor) used 719.40. The CPT codes are different, depending upon the test. We did the Basic Lyme Panel, Complete Co-infection Panel, and CD57 and they are broken up with different CPT codes (see below). IGX should have included CPT codes. Also, they should have included a notation that says: "Note to insurance company: If a CPT code is listed more than one time, please note the CPT code is not a duplicate. They are separate and distinct procedural services. You may use Modifier 59." My insurance company told me to highlight or draw an arrow to this statement so the clerk sees it.

 

Here are the CPT codes listed on ours:

Lyme IFA G/M/A Screen (86618)

Western Blot IGM (86617)

Western Blot IGG (86617)

Babesia Antibody IGG (8631759)

Babesia Antibody IGM (8631759)

Anaplasma Phag IGG (8631759)

B Henselae IGG AB (8661159)

B Henselae IGM AB (8661159)

HME, IGG Antibody (8631759)

HME, IGM Antibody (8631759)

Babesia Fish (8836559)

CD57 (86357)

 

I hope this helps.

Nancy

 

HELP! I'm trying to get reimbursed by UHC for our Lyme & Co-infections panels. UHC says there must be a diagnosis code and a procedure code on each bill.

 

On the Lyme Panel, Igenex put a diagnosis code of 300.3 for all 5 tests, but no procedure code. (And am I going to have a problem with all 5 tests having the same dx code? ie. they'll tell me some are duplicates or something?)

 

And for the co-infections, Igenex didn't give me anything at all. (Or do the CPT codes count for anything?)

 

Can someone who has done this before share the diagnosis & procedure codes with me so I don't have to try to chase them down?

 

~Grace (very much under pressure this morning)

[philamom]

I highly recommend to hightlight or circle the statement about the modifier code. It took me 10 phone calls to explain this to our insurance company after part of it was denied because of the same cpt codes. We eventually got reimbursed.

[philamom]

We just received reimbursement for our most recent Igenex Western Blot, and again, it was not paid properly. This is our 4th time running this test, and, once again they didn't apply the modifier code. I even highlighted it. I think they do it on purpose...and hope you won't fight the charge.

[NancyD]

Ask to speak with a supervisor. The clerks handling the claims don't really know any better.

 

We just received reimbursement for our most recent Igenex Western Blot, and again, it was not paid properly. This is our 4th time running this test, and, once again they didn't apply the modifier code. I even highlighted it. I think they do it on purpose...and hope you won't fight the charge.