Greetings!
I prepare ins appeals to dispute unpd CPTs within a claim for a cardiology group. Routinely, I can send off 10 appeal packets to commercial carriers - all identical procedures with identical or similar diagnosis settings, all have identical resource information such as med nec statement from our senior cardiologist, AMA/CPT statement and descriptions, etc. So many times, the appeal response is extremely varied....such as - 4 granted a favorable determination while the other identical appeals granted unfavorable determination. Has anyone else encountered this situation? or know why?? Reviewer dependent? trying to make sense and find a pattern or guidelines. very frustrating!
thanks for any comments.
Judy Roden
Provider Rep