Primary Care Coding Alert

Question: When a pregnant woman wants to interview a family physician prior to selecting the doctor to care for her child, I report G9001. But Blue Cross Blue Shield Carefirst (federal plan) rejects the code as invalid. Should I appeal the denials?


Maryland Subscriber

Answer: No, you shouldn't challenge the payer's ruling. Code G9001 (Procedures/professional services [temporary]; coordinated care fee, initial rate) is a temporary HCPCS level-II code that insurers created to gather statistics on the code's use prior to possible CPT inclusion. The payer probably doesn't accept the temporary code, which identifies a professional service to establish coordination of care.
 
The code is, however, a good one to use for meet-and-greet visits instead of creating a dummy code.

Even if BCBS considers G9001 a valid code, you-re not guaranteed interview payment. The G900x codes don't contain relative values. Therefore, many insurers that recognize the codes may not cover them.

Try this: Contact your insurance representative and find out what code BCBS accepts for a prospective doctor interview. Remind him that these claims don't list the family physician as the patient's -primary-care physician.- Also, ask whether the payer covers a meet-and-greet visit. Even if the insurer doesn't normally cover the service, it may provide benefits for parents in high-risk situations.

If the insurer considers a meet-and-greet visit a noncovered service, you could charge parents for the visits. Have the future parents sign an advance beneficiary notice stating that if their insurer doesn't pay for the service, they will be responsible for payment.

Before billing the parents, discuss how this policy will affect your public relations. Many practices offer a meet-and-greet visit as a courtesy service that can generate future clients.

Good news: You have a specific diagnostic V code that you should link to the HCPCS level-II interview code: V65.11 (Pediatric prebirth visit for expectant mother).