454-11-7994-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by American Casualty Company of Reading, PA (American Casualty) for two hospital outpatient procedures (HOP) performed at Vista’s facility. On November 29, 2004,[2] and January 17, 2005,[3] the injured worker underwent a lumbar transforaminal epidural steroid injection (ESI), billed under CPT […]
454-11-1907-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures performed at Vista’s facility for the same injured worker on three occasions. The services were provided on March 11, 2004;[1] April 29, 2004;[2] and June 17, 2004.[3] The March 11, 2004 […]
454-11-4905-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures performed at Vista’s facility for the same injured worker on three occasions. The services were provided on February 27, 2003;[1] July 22, 2003;[2] and March 11, 2003.[3] The February 27, 2003 […]
454-11-5439-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for three hospital outpatient procedures (HOP) performed at Vista’s facility on three separate occasions for the same injured worker. The services were provided on May 15, 2003,[1] October 22, 2003,[2] and February 5, 2004.[3] The […]
454-11-6169-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for four hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on March 12, 2004,[1] November 24, 2003,[2] March 5, 2004,[3] and October […]
454-11-7518-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for outpatient services, specifically a lumbar epidural steroid injection (ESI), CPT Code 62311, provided to an injured worker on January 12, 2004. The Administrative Law Judges (ALJs) find that Vista did not present evidence proving […]
454-11-9324-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures (HOP) performed at Vista’s facility for an injured worker. The services were provided on December 16, 2005. The services consisted of a rotator cuff repair, billed under CPT code 23412 and […]
454-12-0478-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures performed at Vista’s facility for the same injured worker on three occasions. The services were provided on April 12, 2007;[1] April 26, 2007;[2] and June 7, 2007.[3] The April 12, 2007 […]
454-11-9532-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by ________ for hospital outpatient (HOP) services—an injection of anesthetic to spinal canal (IASC), CPT Code 64470—provided to an injured worker on December 20, 2004, and on May 2, 2005. The Administrative Law Judge (ALJ) finds that Vista failed to prove […]
454-11-9584-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by ______ for hospital outpatient (HOP) services, specifically a manipulation under anesthesia of a shoulder joint (MASJ), CPT Code 23700, provided to an injured worker on December 14, 2006. The Administrative Law Judge (ALJ) finds that the evidence failed to prove […]