FQHC Billing of 99214 + 90833 Telehealth?

[kboissoneau@hffcc.org]

Hello! We have a psych NP in a FQHC that occasionally bills 99214 and 90833 together for telehealth visits. We keep getting denials because instead of the typical:

G0467
99214
90833

our EMR is sending it out:

G2025,95
90833,95

By suppressing the 99214 informational line, NGS is denying these claims stating 90833 is not a valid CPT for G2025. Our vendor will not add 99214 to the claim unless we find guidance as proof. Has anyone seen this?

 

[cindyzam2001@yahoo.com]

What state and what ins?

 

[TThivierge]

Hello! We have a psych NP in a FQHC that occasionally bills 99214 and 90833 together for telehealth visits. We keep getting denials because instead of the typical:

G0467
99214
90833

our EMR is sending it out:

G2025,95
90833,95

By suppressing the 99214 informational line, NGS is denying these claims stating 90833 is not a valid CPT for G2025. Our vendor will not add 99214 to the claim unless we find guidance as proof. Has anyone seen this?

Hi Kboisson
I would not bill these 2 CPT together UNLESS each Dx. is discussed in the documentation and proper dx linked to the proper CPT. Do not use the G code. All psych dx go to 90832-95 telehealth, then telehealth (CPT codes 98000-98015) if new or est.pt. 99214- 25 is for face to face only . You should use the telehealth series of CPT 98004 plus documentation of time minutes used for each section. Then link chronic dx to telehealth CPT. Also add in type of clinical LCSW, MD vs PA, NP and their specialty AF modifier . You know a LCSW cannot bill CPT 99213 only 90832.
I hope this data helps you
Lady T