Wiki 99395 denied as incidental

[Katiedid64]

Our clinic recently had a denial of 99395 (stating it was incidental) for the following:
99395 - Z00.00
99213-25 -- D48.9 R05.3
11140- D48.9
Any suggestions as to how to get the 99395 paid for?

 

[csperoni]

Different payors will have different rules on this. Most will pay for both a preventive and a problem oriented on the same day. Some will pay both, but at a 50% reduction on E&M. Others will simply NOT pay for both, regardless of the documentation or coding guidelines. Additionally, which code they want the -25 on may vary.
Bottom line - you need to follow payor policy on this.
PS - I am assuming a typo in 11140 perhaps 11400??

 

[rstroup]

You need to append modifier 25 on 99395 as well.

--
Ryan Stroup, CPC

 

[Katiedid64]

Thank you! and yep that was a typo