|
DATE OF |
TOT |
CPT |
|
PPO |
NON |
|
PLN |
PT. |
|
|
1/24/96 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
1/24/96 |
100.00 |
80019 |
19 Clinical Chemistry Tests |
60.80 |
|
39.20 |
39.20 |
|
|
|
1/24/96 |
150.00 |
80072 |
Arthritis Panel |
81.75 |
|
68.25 |
68.25 |
|
|
|
1/24/96 |
100.00 |
80092 |
Thyroid Panel With Tsh |
24.51 |
|
75.49 |
75.49 |
|
|
|
1/24/96 |
75.00 |
82787 |
Immunoglobulin Subclasses |
|
|
75.00 |
75.00 |
|
|
|
1/24/96 |
75.00 |
82787 |
Immunoglobulin Subclasses |
|
75.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
75.00 |
82787 |
Immunoglobulin Subclasses |
|
75.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
75.00 |
82787 |
Immunoglobulin Subclasses |
|
75.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
75.00 |
83520 |
Immunoassays, Not Specified |
27.82 |
|
47.18 |
47.18 |
|
|
|
1/24/96 |
75.00 |
84165 |
Protien; Electrophoretic |
29.85 |
|
45.15 |
45.15 |
|
|
|
1/24/96 |
50.00 |
84436 |
Thyroxine; Total |
22.00 |
|
28.00 |
28.00 |
|
|
|
1/24/96 |
35.00 |
84479 |
Thyroid Hormone |
11.20 |
|
23.80 |
23.80 |
|
|
|
1/24/96 |
100.00 |
84481 |
Triiodothyronine T3; Free |
30.00 |
|
70.00 |
70.00 |
|
|
|
1/24/96 |
25.00 |
85007 |
Blood Count; Man. Diff |
18.00 |
|
7.00 |
7.00 |
|
|
|
1/24/96 |
35.00 |
85024 |
Hemogram & Platelet Count |
22.40 |
|
12.60 |
12.60 |
|
|
|
1/24/96 |
20.00 |
85048 |
White Blood Cell |
13.00 |
|
7.00 |
7.00 |
|
|
|
1/24/96 |
25.00 |
85651 |
Sedimentation Rate |
15.20 |
|
9.80 |
9.80 |
|
|
|
1/24/96 |
100.00 |
86320 |
Imminoelectrophoreisis |
44.00 |
|
56.00 |
56.00 |
|
|
|
1/24/96 |
75.00 |
86329 |
Immunodiffusion |
22.50 |
|
52.50 |
52.50 |
|
|
|
1/24/96 |
75.00 |
86329 |
Immunodiffusion |
|
75.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
75.00 |
86329 |
Immunodiffusion |
|
75.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
75.00 |
86378 |
Migration Inhibitory Factor |
|
|
75.00 |
75.00 |
|
|
|
1/24/96 |
100.00 |
86644 |
Cytomegalovirus |
|
100.00 |
|
|
|
Not Med. Nec; Torch Screen Is For Poss Exposure To 4 Diff Organisms, Only 1 Of Which Could Even Remotely Be Considered As The Cause For Patients Illness |
|
1/24/96 |
100.00 |
86645 |
CYTOMEGALOVIRUS,Igm |
51.88 |
|
48.12 |
48.12 |
|
|
|
1/24/96 |
50.00 |
86694 |
Herpes Simplex Non Specific |
|
50.00 |
|
|
|
Not Med. Nec; Torch Screen Is For Poss Exposure To 4 Diff Organisms, Only 1 Of Which Could Even Remotely Be Considered As The Cause For Patients Illness |
|
1/24/96 |
25.00 |
86694 |
Herpes Simplex Non Specific |
|
25.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
50.00 |
86695 |
Herpes Simplex, Type 1 |
0.93 |
|
49.07 |
49.07 |
|
|
|
1/24/96 |
25.00 |
86695 |
Herpes Simplex, Type 1 |
|
25.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
50.00 |
86701 |
Hiv-1 |
|
|
50.00 |
50.00 |
|
|
|
1/24/96 |
50.00 |
86762 |
Rubella |
|
50.00 |
|
|
|
Not Med. Nec; Torch Screen Is For Poss Exposure To 4 Diff Organisms, Only 1 Of Which Could Even Remotely Be Considered As The Cause For Patients Illness |
|
1/24/96 |
25.00 |
86762 |
Rubella |
|
25.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
50.00 |
86777 |
Toxoplasma |
|
50.00 |
|
|
|
Not Med. Nec; Torch Screen Is For Poss Exposure To 4 Diff Organisms, Only 1 Of Which Could Even Remotely Be Considered As The Cause For Patients Illness |
|
1/24/96 |
25.00 |
86777 |
Toxoplasma |
|
25.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
100.00 |
86787 |
Treponema Pallidum Varicella |
60.37 |
|
39.63 |
39.63 |
|
|
|
1/24/96 |
100.00 |
86787 |
Treponema Pallidum Varicella |
|
100.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
100.00 |
86800 |
Thyroglobulin |
59.40 |
|
40.60 |
40.60 |
|
|
|
1/24/96 |
125.00 |
88180 |
Flow Cytometry |
|
|
125.00 |
125.00 |
|
|
|
1/24/96 |
125.00 |
88180 |
Flow Cytometry |
|
125.00 |
|
|
|
Duplicate Charges |
|
1/24/96 |
250.00 |
99244 |
Office Cons. New Or Existing |
85.68 |
|
164.32 |
164.32 |
|
|
|
2/9/96 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
2/9/96 |
100.00 |
80019 |
19 Clinical Chemistry Tests |
60.80 |
|
39.20 |
29.20 |
|
|
|
2/9/96 |
100.00 |
80092 |
Thyroid Panel With Tsh |
24.51 |
|
75.49 |
75.49 |
|
|
|
2/9/96 |
100.00 |
82378 |
Carcinoembryonic Antigen |
50.93 |
|
49.07 |
49.07 |
|
|
|
2/9/96 |
50.00 |
84436 |
Thyroxine; Total |
22.00 |
|
28.00 |
28.00 |
|
|
|
2/9/96 |
35.00 |
84479 |
Thyroid Hormone |
11.20 |
|
23.80 |
23.80 |
|
|
|
2/9/96 |
100.00 |
84481 |
Triiodothyronne T3; Free |
30.00 |
|
70.00 |
70.00 |
|
|
|
2/9/96 |
35.00 |
85024 |
Hemogram & Platelet Count |
22.40 |
|
12.60 |
12.60 |
|
|
|
2/9/96 |
25.00 |
85651 |
Sedimentation Rate |
15.20 |
|
9.80 |
9.80 |
|
|
|
2/9/96 |
50.00 |
86060 |
Antistreptolysin 0; Titer |
23.75 |
|
26.25 |
26.25 |
|
|
|
2/9/96 |
50.00 |
86140 |
C Reactive Protein |
35.30 |
|
14.70 |
14.70 |
|
|
|
2/9/96 |
55.00 |
86140 |
C Reactive Protein |
|
55.00 |
|
|
|
Duplicate Charges |
|
2/9/96 |
100.00 |
86215 |
Deoxyriboneucleic Acid Antibodies |
66.40 |
|
33.60 |
33.60 |
|
|
|
2/9/96 |
50.00 |
86255 |
Flourescent Antibody Screen |
20.04 |
|
29.96 |
29.96 |
|
|
|
2/9/96 |
75.00 |
86255 |
Flourescent Antibody Screen |
45.04 |
|
29.96 |
29.96 |
|
|
|
2/9/96 |
75.00 |
86256 |
Flourescent Antibody Titer |
33.00 |
|
42.00 |
42.00 |
|
|
|
2/9/96 |
75.00 |
86256 |
Flourescent Antibody Titer |
|
75.00 |
|
|
|
Duplicate Charges |
|
2/9/96 |
75.00 |
86256 |
Flourescent Antibody Titer |
|
75.00 |
|
|
|
Duplicate Charges |
|
2/9/96 |
75.00 |
86256 |
Flourescent Antibody Titer |
|
|
|
|
|
|
|
2/9/96 |
75.00 |
86256 |
Flourescent Antibody Titer |
|
|
|
|
|
|
|
2/9/96 |
75.00 |
86376 |
Microsomal Antibodies |
35.80 |
|
39.20 |
39.20 |
|
|
|
2/9/96 |
75.00 |
86378 |
Migration Inhibitory Factor |
|
|
75.00 |
75.00 |
|
|
|
2/9/96 |
225.00 |
86617 |
Borrelia Burgdorferi |
174.99 |
|
50.01 |
50.01 |
|
|
|
2/9/96 |
225.00 |
86617 |
Borrelia Burgdorferi |
|
225.00 |
|
|
|
Duplcate Charges |
|
2/9/96 |
100.00 |
86800 |
Thyroglobulin |
59.40 |
|
40.60 |
40.60 |
|
|
|
2/9/96 |
150.00 |
99215 |
Office Visit |
53.08 |
|
96.92 |
96.92 |
|
|
|
12/10/96 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/10/96 |
30.00 |
85610 |
Prothrombin Time |
4.50 |
|
25.50 |
25.50 |
4.60 |
|
|
12/13/96 |
30.00 |
84999 |
Unlisted Chemistry Procedure |
|
30.00 |
|
|
|
No Documentation To Support Charge |
|
12/13/96 |
30.00 |
85610 |
Prothrombin Time |
4.50 |
|
25.50 |
25.50 |
|
|
|
12/13/96 |
15.00 |
99000 |
Specimen Handling |
|
15.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
1/2/97 |
20.00 |
36415 |
Routine Venipuncture |
|
25.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
1/2/97 |
30.00 |
85610 |
Prothrombin Time |
4.50 |
|
25.50 |
20.40 |
5.10 |
|
|
1/2/97 |
35.00 |
85732 |
Thromboplastin Time; Subs. |
15.40 |
|
19.60 |
15.68 |
3.92 |
|
|
5/22/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
5/22/97 |
100.00 |
80019 |
19 Clinical Chemistry Tests |
|
100.00 |
|
|
|
No Medical Necessity-Not Relevant Or Indicated Given Patient's Symptoms At Time Of Visit |
|
5/22/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
18.02 |
|
16.98 |
13.58 |
3.37 |
|
|
5/22/97 |
30.00 |
85610 |
Prothrombin Time |
8.00 |
|
22.00 |
17.60 |
4.40 |
|
|
5/22/97 |
25.00 |
85651 |
Sedimentation Rate |
|
25.00 |
|
|
|
Test Could Not Indicate Positive Response To Treatment As They Were Unremarkable Before Treatment Was Started |
|
5/22/97 |
50.00 |
86140 |
C Reactive Protein |
|
50.00 |
|
|
|
Test Could Not Indicate Positive Response To Treatment As They Were Unremarkable Before Treatment Was Started |
|
5/22/97 |
100.00 |
99212 |
Office Visit |
52.00 |
|
48.00 |
38.40 |
9.60 |
|
|
6/9/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
6/9/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
|
65.00 |
|
|
|
Medical Necessity Not Established |
|
6/9/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
18.02 |
|
16.98 |
13.47 |
3.40 |
|
|
6/9/97 |
30.00 |
85610 |
Prothrombin Time |
|
30.00 |
|
|
|
Medical Necessity Not Established |
|
6/9/97 |
400.00 |
86256 |
Flourescent Antibody Titer |
358.00 |
|
42.00 |
3.60 |
0.90 |
$30.00 Overpayment From 81072454040h Recouped |
|
6/9/97 |
65.00 |
99212 |
Office Visit |
12.00 |
|
48.00 |
38.40 |
9.60 |
|
|
6/16/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
6/16/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
25.80 |
|
39.30 |
31.36 |
7.84 |
|
|
6/16/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
|
35.00 |
|
|
|
Results Not Effective As Antibiotics Were Completed About This Time |
|
6/16/97 |
30.00 |
85610 |
Prothrombin Time |
16.78 |
|
13.22 |
10.57 |
2.65 |
|
|
7/3/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
7/3/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
25.80 |
|
39.20 |
31.36 |
7.84 |
|
|
7/3/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
18.02 |
|
16.98 |
13.58 |
3.40 |
|
|
7/3/97 |
30.00 |
85610 |
Prothrombin Time |
16.78 |
|
13.22 |
10.57 |
2.65 |
|
|
7/3/97 |
65.00 |
99213 |
Office Visit |
21.90 |
|
43.10 |
34.48 |
8.62 |
|
|
7/30/97 |
65.00 |
99213 |
Office Visit |
|
65.00 |
|
|
|
Documentation States "Unchanged"; No Med Necissity Established |
|
9/17/97 |
75.00 |
J0696 |
Rocephin |
37.50 |
|
37.50 |
30.00 |
7.50 |
|
|
9/17/97 |
10.00 |
J3490 |
Unclassified Drugs |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/17/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/17/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
9.75 |
|
55.25 |
44.20 |
11.05 |
|
|
9/17/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
5.25 |
|
29.75 |
23.80 |
5.95 |
|
|
9/17/97 |
30.00 |
85610 |
Prothrombin Time |
8.00 |
|
22.00 |
17.60 |
4.40 |
|
|
9/17/97 |
25.00 |
85651 |
Sedimentation Rate |
|
25.00 |
|
|
|
Results Never Abnormal; Could Not Be Used To Document Response To Therapy |
|
9/17/97 |
35.00 |
86140 |
C Reactive Protein |
|
35.00 |
|
|
|
Results Never Abnormal; Could Not Be Used To Document Response To Therapy |
|
9/17/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/17/97 |
65.00 |
99213 |
Office Visit |
17.00 |
|
48.00 |
38.40 |
9.60 |
|
|
9/24/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/24/97 |
150.00 |
J3490 |
Rocephin |
112.50 |
|
37.50 |
30.00 |
7.50 |
|
|
9/24/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/24/97 |
65.00 |
99211 |
Office Visit |
30.00 |
|
35.00 |
28.00 |
28.00 |
|
|
9/29/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/29/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
9/29/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
9/29/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/2/97 |
10.00 |
J3490 |
Unclassified Drugs |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/2/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/2/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
|
65.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
30.00 |
85610 |
Prothrombin Time |
|
30.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
25.00 |
85651 |
Sedimentation Rate |
|
25.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
35.00 |
86140 |
C Reactive Protein |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/2/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/2/97 |
65.00 |
99213 |
Office Visit |
|
65.00 |
|
|
|
Medical Necessity Not Established |
|
10/9/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/9/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/9/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/9/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/14/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/14/97 |
20.00 |
36415 |
Routine Venipuncture |
|
20.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/14/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
|
65.00 |
|
|
|
Medical Necessity Not Established |
|
10/14/97 |
125.00 |
84402 |
Testosterone; Free |
54.23 |
|
70.77 |
56.62 |
14.15 |
|
|
10/14/97 |
125.00 |
84403 |
Testosterone; Total |
80.65 |
|
44.35 |
35.48 |
8.87 |
|
|
10/14/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/14/97 |
30.00 |
85610 |
Prothrombin Time |
16.78 |
|
13.22 |
10.58 |
2.64 |
|
|
10/14/97 |
25.00 |
85651 |
Sedimentation Rate |
|
25.00 |
|
|
|
Medical Necessity Not Established |
|
10/14/97 |
35.00 |
86140 |
C Reactive Protein |
|
35.00 |
|
|
|
Results Never Abnormal; Could Not Be Used To Document Response To Therapy |
|
10/14/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/14/97 |
50.00 |
99212 |
Office Visit |
19.00 |
|
31.00 |
24.80 |
6.20 |
|
|
10/20/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Need Clinical Info |
|
10/20/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/20/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/20/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/23/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/23/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/23/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/23/97 |
50.00 |
99212 |
Office Visit |
|
50.00 |
|
|
|
Medical Necessity Not Established |
|
10/27/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/27/97 |
37.50 |
J0696 |
Rocephin |
|
37.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/27/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/27/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
10/30/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
10/30/97 |
50.00 |
90782 |
Testerone Cypionate |
|
50.00 |
|
|
|
No Medical Necessity As Test Results Were Not Abnormal |
|
10/30/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
10/30/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
11/3/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/3/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Medical Necessity Not Established |
|
11/3/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/3/97 |
50.00 |
99212 |
Office Visit |
|
50.00 |
|
|
|
Medical Necessity Not Established |
|
11/6/97 |
10.00 |
J3490 |
Lidocain |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/6/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
11/6/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/6/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
11/10/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/10/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
11/10/97 |
35.00 |
88211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
11/10/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/13/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/13/97 |
75.00 |
J0696 |
Rocephin |
|
75.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
11/13/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/13/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
11/17/97 |
10.00 |
J3490 |
Lidocain |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/17/97 |
150.00 |
J3490 |
Rocephin |
|
150.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
11/17/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/17/97 |
35.00 |
99211 |
Office Visit |
15.63 |
|
19.37 |
15.50 |
3.87 |
|
|
11/22/97 |
65.00 |
99213 |
Office Visit |
|
65.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/24/97 |
10.00 |
J3490 |
Lidocaine |
1.50 |
8.50 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/24/97 |
150.00 |
J3490 |
Rocephin |
22.50 |
127.50 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
11/24/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
32.84 |
17.16 |
|
|
|
Global; Should Not Be Separate Charge |
|
11/24/97 |
50.00 |
99212 |
Office Visit |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/4/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/4/97 |
150.00 |
J3490 |
Rocephin |
|
150.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
12/4/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/4/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
12/8/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/8/97 |
150.00 |
J3490 |
Rocephin |
|
150.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
12/8/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/8/97 |
50.00 |
99212 |
Office Visit |
|
50.00 |
|
|
|
Medical Necessity Not Established |
|
12/11/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/11/97 |
150.00 |
J3490 |
Rocephin |
|
150.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
12/11/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/11/97 |
35.00 |
99211 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
12/15/97 |
10.00 |
J3490 |
Lidocaine |
|
10.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/15/97 |
150.00 |
J3490 |
Rocephin |
|
150.00 |
|
|
|
Intramuscular Injections Not Effective For Eradication Of Lyme Disease * |
|
12/15/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
50.00 |
|
|
|
Global; Should Not Be Separate Charge |
|
12/15/97 |
35.00 |
99212 |
Office Visit |
|
35.00 |
|
|
|
Medical Necessity Not Established |
|
12/18/97 |
150.00 |
J3490 |
Unclassified Drugs |
|
|
150.00 |
120.00 |
30.00 |
|
|
12/18/97 |
10.00 |
J3490 |
Unclassified Drugs |
|
|
10.00 |
8.00 |
2.00 |
|
|
12/18/97 |
20.00 |
36415 |
Routine Venipuncture |
11.75 |
|
8.25 |
6.60 |
1.65 |
|
|
12/18/97 |
65.00 |
80019 |
19 Clinical Chemistry Tests |
25.80 |
|
39.20 |
31.36 |
7.84 |
|
|
12/18/97 |
75.00 |
84165 |
Protien; Electrophoretic |
38.88 |
|
36.12 |
28.89 |
7.23 |
|
|
12/18/97 |
35.00 |
85024 |
Hemogram & Platelet Count |
18.02 |
|
16.98 |
13.58 |
3.40 |
|
|
12/18/97 |
30.00 |
85610 |
Prothrombin Time |
4.50 |
|
25.50 |
20.40 |
5.10 |
|
|
12/18/97 |
30.00 |
85730 |
Thromboplastin Time |
|
30.00 |
|
|
|
Medical Necessity Not Established |
|
12/18/97 |
100.00 |
86320 |
Immunoelectrophoresis |
52.45 |
|
47.55 |
38.04 |
9.51 |
|
|
12/18/97 |
50.00 |
90782 |
Ther./Diagnostic Injection |
|
|
50.00 |
40.00 |
10.00 |
|
|
12/18/97 |
100.00 |
99214 |
Office Visit |
37.08 |
|
62.92 |
50.34 |
12.58 |
|
* Medical literature indictes that
it is not possible to deliver an effective treatment dose for eradication of Lyme disease with this antibiotic
using the intramuscular route, as 2 mg. daily intravenously are required to accomplish this. Documentation includes
"Lyme Borreliosis and Related Disorders," by Kenneth Liegner, MD and Conn's Current Therapies. 10/23/98
