Wiki 99417 denial for alternative services

[crystalkinney99@yahoo.com]

Hello,

I'm new to posting here. Hopefully, I'm doing it correctly and can get some feedback. We have an MHNP on staff who bills based on time. Time is documented in the patient encounter. We billed 99215 with 99417. 99215 was paid; however, 99417 was denied. The denial read" COB8: Alternative services were available, and should have been utilized".

I'm stuck on what the "alternative services" are. Through research, I came across consultation codes 99242-99245. I'm wondering if the primary code of 99215 is causing the issue, and if a consultation code, along with the 99417, should have been billed instead of an E/M. I question consultation codes for nurse practitioners. Are consultation codes appropriate for a BH nurse practitioner?

The only alternative I found to 99417 was G2212, which is for Medicare. I really think it doesn't have anything to do with 99417 per se, but the primary code that we're billing.

Any insight, advice is greatly appreciated!

 

[jkyles]

Hi there, it is possible the payer wants the psychotherapy add-on codes. I recommend checking the payer's policies.

For E/M prolonged services some private payers do use G2212 because they prefer CMS' stricter time structure. So far as consults are concerned, fewer and fewer private payers cover consults, which have strict requirements if a payer does accept them.

 

[crystalkinney99@yahoo.com]

Hi there, it is possible the payer wants the psychotherapy add-on codes. I recommend checking the payer's policies.

For E/M prolonged services some private payers do use G2212 because they prefer CMS' stricter time structure. So far as consults are concerned, fewer and fewer private payers cover consults, which have strict requirements if a payer does accept them.

That didn't even cross my mind, as our provider is providing more medication management than psychotherapy. I was thinking along more of the medical side than the psych. I will definitely read up on these and give them a shot to see what the claim does. Thank you so much for some direction!! I learn something new every day!!

 

[jkyles]

Got it. In that case the codes might not be appropriate, but do give the psych section of the CPT Manual's Medicine chapter a review.

If you haven't already, check out the available billing/coding guidance from specialty societies like the APA. The payer always has the final word, of course.