Wiki 99051 denied.... why?

[GoLeun22]

So my office sees patients after 5pm on a few days a week. They bill a 99051 in addition to the office visit, and sometimes the well visit. Some insurance's pay, and some deny stating inclusive to primary procedure. I recently got a denial from CIGNA stating that you cannot bill a 99051 on same date of service as an E/M visit. From what I can tell in the book, this code is supposed to be billed in addition to the office visit. Is this just CIGNA?

Thanks,
Lisa

 

[ollielooya]

Hi, Lisa
We had huge issue with this only the code was slightly different---99058. Do you have access to their company Policy for 99051? We did for the 99058 (which in their Network bulletin was stated as a payable code) and yet they denied it anyway even when correctly sent with the required code = "in addition to basic sentence". We had their policy that they would pay and even after a year of dealing with upper management and continual followups for proof with first and second appeals, still did not receive payment. These codes are considered "adjunct" codes and must not be submitted alone.

Wish I could be of further help because there never was a satisfactory resolution to the matter as doctor moved and brought billing back in house. Hopefully others will comment...