Look for resubmissions after denials for claims for the same member with changes to the procedure codes. Review physical therapy providers who are reporting code 97016- application of modality- vasopneumatic devices. They may be using one of these devices to reduce the patient's swelling after a therapeutic exercise session.
CPT codes 35311 and 35526: The commenter recommended changing the override specialty from vascular surgery to cardiac surgery. CPT codes 38382, 43108, 43118, 43123, 43360, 43405 and 43425: The commenter recommended changing the override specialty from general surgery to thoracic surgery.