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Re: No Show CPT Code?

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Vern -

There is no CPT code for a missed appointment or failure to show for an appointment. Since no action was done, no code exists. Health care providers can establish a fee for such incidents, but since it is an issue of patient responsibility it would be highly unusual for any third party payor to reimburse for a patient failing to keep an appointment. If you software requires some type of five digit identifier, you could create anything for in office purposes.

Under Oregon Workers' Compensation (436-009-0015), there is no fee for missed appointments except for a closing exam, an evaluation requested by the Workers' Compensation Division, an exam requested by the insurer, or for a Worker Requested Medical Examination unless 24 hours notice is given. Then the charge is 50% of the examination or testing fee. The code used in this case is P0005, but this is specific only to Oregon Workers' Compensation for the circumstances outlined above.

Tom Freedland

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Well since the PIP carriers now must follow the W/C fee schedule would not P0005 apply?

Vern Saboe

Re: "No Show CPT Code?"

Vern -

There is no CPT code for a missed appointment or failure to show for an appointment. Since no action was done, no code exists. Health care providers can establish a fee for such incidents, but since it is an issue of patient responsibility it would be highly unusual for any third party payor to reimburse for a patient failing to keep an appointment. If you software requires some type of five digit identifier, you could create anything for in office purposes.

Under Oregon Workers' Compensation (436-009-0015), there is no fee for missed appointments except for a closing exam, an evaluation requested by the Workers' Compensation Division, an exam requested by the insurer, or for a Worker Requested Medical Examination unless 24 hours notice is given. Then the charge is 50% of the examination or testing fee. The code used in this case is P0005, but this is specific only to Oregon Workers' Compensation for the circumstances outlined above.

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The new PIP rule appears to apply to fees only. It does not appear to carry over to other applications. Were one to be able to use this code, one could then argue that other aspects of the W/C rules would also apply. I think we had that discussion earlier. That is one Pandora's box I believe should be left closed for the time being.

Tom Freedland

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