Wiki 99254, 99223 inclusive to 93306, 93351

[mcgraws]

I would like to know if anyone is having issues with insurance compnaies denying claims billed as 99254.25, 93306.26, 93016, 93018 and the insurance company stating the 99254.25 is inclusive to 93306.26.

Our office is receiving denials on the 93306.26, 93351.26, 93312.26, 93325.26, 93320.26 when it is done the same day as 99254 or 99232. The insurance companies mainly involved are Anthem, Unite Healthcare and Tricare.

We have not been able to locate any information regarding this matter.

Any input would be greatly appreaciated..

Tonya

 

[Jess1125]

I haven't had any issues in the last couple of weeks with this (maybe the insurance companies corrected their system finally!) but I was having it seemed like a couple denials every day on this with certain insurance companies not paying for the test separate from the E/M service. I gave the following to our insurance staff to appeal denial.

From the CPT book in the E/M guidelines it states:

"The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are NOT INCLUDED IN THE LEVELS OF E/M SERVICES. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported SEPARATELY, IN ADDITION TO THE APPROPRIATE E/M CODE. The physician's interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report may also be reported SEPARATELY, using the appropriate CPT code with modifier 26 attached."

This was under the "Levels of E/M Services" section.

Jessica CPC, CCC

 

[mcgraws]

Thanks Jessica. Has your staff had any luck with their appeals? It is not right that these insurance companies are requiring a 59 on a procedure that does not need it. It is improper billing.

Thanks,

Tonya

 

[Jess1125]

Thanks Jessica. Has your staff had any luck with their appeals? It is not right that these insurance companies are requiring a 59 on a procedure that does not need it. It is improper billing.

Thanks,

Tonya

Honestly, I just know of one claim where it was still denied after appeal. Needless to say, I'm having that one sent back to the insurance company because it is SO wrong not to be paying the diagnostic test separate from the E/M.

Jessica CPC, CCC