15 Fla. L. Weekly Supp. 829b
Insurance — Personal injury protection — Recoding CPT codes — No improper recoding occurred where code under which insurer paid bill was synonymous with CPT code referenced in bill for electrical stimulation
ORTHOPEDIC HEALTH CENTER, INC., a Florida Corporation (assignee of Sanda, Richard), Plaintiff, v. PROGRESSIVE AMERICAN INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 07-21158 CC 23 (04). June 11, 2008. Eric Wm. Hendon, Judge. Counsel: Russel Lazega. Reuven T. Herssein, Law Offices of Herssein & Herssein, PA, North Miami.
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AS TO COUNT I OF COMPLAINT
(Declaratory Relief regarding whether Defendant improperly recoded Plaintiff’s Code 97014 to G0283)
THIS CAUSE came before the Court for hearing on June 3, 2008 on Defendant’s Motion for Summary Judgment with respect to Count I of Plaintiff’s Complaint. Count I of Plaintiff’s Complaint seeks Declaratory Relief as to whether Defendant improperly recoded Plaintiff’s charges for electrical stimulation in violation of F.S. 627.736(5)(b)(1)(e). The Court, having reviewed the Motion, responses and legal authorities, and having heard argument of counsel, finds as follows:
Factual Background: This is a P.I.P. case. Defendant has moved for Summary Judgment as to Count I of Plaintiff’s Complaint which seeks Declaratory Relief to determine whether Defendant recoded Plaintiff’s charges for electrical stimulation (billed as CPT Code 97014) when it issued payment of two times the allowable Medicare Part B schedule for HCPCS Code G0283.
Legal Conclusion: The Court, having considered the arguments of counsel, the motions, the statute, and respective coding guides finds that Code 97014 is synonymous with Code G0283. Accordingly, there is effectively a distinction with no difference and therefore, no changing of the Code by Defendant. Accordingly, Defendant’s Motion for Summary Judgment as to Count I of the Complaint is hereby granted.
