State Farm v. 14789
In State Farm v. 14789 filed in 2018, State Farm claimed that the doctor, and orthopedic surgeon, was billing every patient as a 99204 and 99205 examination code. The doctor was also billing for 95851 (“range of motion measurements and report”) and 76140 (“consultation on x-ray examination”) on the same date of service even though that “procedure” should been included as part of the 99204 and 99205 exam. State Farm also claimed that the doctor’s 99204 examination report wasn’t detailed enough to qualify for a level 4 code.
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company, therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.