Wiki 83036 A1c help with payment

[mgarcia400]

I work for Primary Care office. Patient came in for A1C check. DX was E11.9.
Billed to BC insurance 99213, 83036- QW, 3051F
Insurance denied payment of 83036 stating "We cant pay for this service unless billed with primary procedure. If the primary procedure wasn't covered we owe no payment"

The last time patient had A1c checked in office was 9 months prior.

There was only the one dx. Should it have been something different? Why wouldn't dx E11.9 work?

Any input is appreciated.

 

[domaha28]

We have to put a referring physician on the 83036 with the QW. Maybe they are looking into more specific dx code. Every payer and state is different. I would check with the payer.