Anthem Blue Cross to review level 5 emergency room claims Anthem Blue Cross announced in its December Professional Network Update that, beginning January 1, 2016, it will initiate a pre-payment review of level 5 emergency department visits billed with CPT 99285 or G0384. Anthem has advised CMA that it will focus on level 5 emergency department visits that are billed in combination with diagnosis codes that “are an unlikely combination for high level visits.” The payor will exclude claims billed with critical care, observation or inpatient admissions. Claims with CPT codes 99285 and G0384 that are selected by Anthem for pre-payment ... February 3, 2016 General Emergency Departments, Emergency Rooms, Emergency Services, Anthem Blue Cross 0 0 Comment Read More »
