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Down Coding

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My office is experiencing a new trend with State Farm.

They capriciously down code services and tell the patient we billed incorrectly.

Previously, when the down coding was appealed and the services were documented

with chart notes State Farm would re code and pay at the proper fee

schedule. Lately however I am told that the State Farm is refusing to re

code and saying they can do as they wish. I have two questions, is anyone

else experiencing this and is there an OAR or a specific rule/code that I can

quote to demonstrate why they cannot just decide what codes they would like to

pay for?

L. C. Lubcke, DC, DABCO

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