Volume 17

17 Fla. L. Weekly Supp. 209a

Online Reference: FLWSUPP 1703DIA2Insurance — Personal injury protection — Claim form — Professional license number — Where medical provider failed to include professional license number of individual provider who actually performed services billed on claim form, provider’s bills are non-compensable

17 Fla. L. Weekly Supp. 208a

Online Reference: FLWSUPP 1703DIAZInsurance — Personal injury protection — Claim form — Professional license number — Where medical provider failed to include professional license number of individual provider who actually performed services billed on claim form, provider’s bills are non-compensable

17 Fla. L. Weekly Supp. 1164a

Online Reference: FLWSUPP 1712NUBEInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Where there was conflicting testimony concerning whether videofluoroscopy machine used by medical provider was synonymous with cineradiography or videoradiography machines covered by CPT code applied by insurer, trial court erred in entering summary judgment finding that insurer applied correct code

17 Fla. L. Weekly Supp. 394a

Online Reference: FLWSUPP 1705WHITInsurance — Personal injury protection — Delay in payment — Request for information or documentation — Request in explanation of benefits for specific description of non-specific CPT code did not toll time for payment of benefits where claim form submitted to insurer lists description of code as “cervical pillow”

17 Fla. L. Weekly Supp. 854b

Online Reference: FLWSUPP 1709 JARBInsurance — Personal injury protection — Coverage — Medical expenses — Claim form — CPT coding — National Corrective Coding Initiative edits apply to PIP claims — Although provider submitted HCFA form which listed office visit code without required -25 modifier to indicate that it was distinct procedure from chiropractic manipulation performed on the same date, medical bill was nonetheless substantially compliant where provider’s accompanying SOAP notes listed the office visit code with a -25 modifier

17 Fla. L. Weekly Supp. 1057a

Online Reference: FLWSUPP 1711JONEInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Evidence — Error to exclude affidavit of insurer’s non-physician expert regarding correctness of CPT code on claim form where PIP statute does not require that insurer refute medical provider’s CPT code determination with physician’s affidavit — Where excluded affidavit and provider’s deposition present material factual dispute regarding treatment billed as disputed CPT code, summary judgment and final judgment are reversed

17 Fla. L. Weekly Supp. 830c

Online Reference: FLWSUPP 1709VELEInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Where PIP statute requires compliance with Medicare’s National Correct Coding Initiative, which provides that medical provider cannot bill lesser code separately on same date as provider bills bundled code that includes lesser code, insurer is not required to pay charge for lesser code

17 Fla. L. Weekly Supp. 826a

Online Reference: FLWSUPP 1709ALEXInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — National Correct Coding Initiative is incorporated in Florida PIP law as part of Medicare pay system — Where medical provider improperly unbundled services when billing, neither insured nor insurer was obligated to pay provider for unbundled amounts — Question certified

17 Fla. L. Weekly Supp. 1029c

Online Reference: FLWSUPP 1710APONInsurance — Personal injury protection — Coverage — Medical expenses — CPT codes — Unbundling

17 Fla. L. Weekly Supp. 1029a

Online Reference: FLWSUPP 1710CORTInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — National Correct Coding Initiative is incorporated in Florida PIP law as part of Medicare pay system — Where medical provider improperly unbundles services when billing for comprehensive treatment charge and component treatment charge, neither insurer that paid comprehensive treatment charge nor insured was obligated to pay for unbundled amount — Question certified