Stephen Mellor Secures Defense Judgment

August 4, 2011

Roig Lawyers partner, Stephen G. Mellor, secured summary judgment in favor of State Farm in the County Court of Broward County.

Hallandale Beach Ortho. submitted bills to State Farm for the re-reading of two MRI scans. State Farm had previously paid the technical and professional component of these MRIs to another provider. State Farm argued that it was not responsible for the re-read having already paid, and that the readings (CPT 72141 and 72148) were unbundled from the more comprehensive evaluation code of CPT 99244 and should not be paid separately.

State Farm relied on the No Fault statute itself which provides that insurers are not required to pay for unbundled services, and the Physician’s Current Procedural Terminology (CPT) book which is referenced in F.S. 627.736(5), and which provides that review of diagnostic tests is included in CPT 99244 as part of the complexity of medical decision making. State Farm submitted an affidavit of coding expert in support of its position. The Plaintiff failed to produce counter evidence on the issue of coding and argued expert testimony was not warranted. The Court agreed with State Farm’s reliance on the CPT book and agreed the re-read was included in the evaluation code and Plaintiff had unbundled the charges.

Final Summary Judgment entered in favor of State Farm. This Summary Judgment was affirmed on Plaintiff’s appeal by the Circuit Court sitting in its Appellate Capacity.