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Wiki 99401 and E/M

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tracieschmutz@gmail.com

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Spring Valley, WI
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We have a few providers that out of blue has started billing 99401 and E/M on literally ever visit. They have time and a reason they counseled. Why in every visit? Also seems Medicare doesn't accept. Guidance one this please. To me it looks like a red flag
 
Tracieschmutz
Well depends on provider s documentation, minutes listed in record, did add modifier 25 to Eval Mgnt and dx code linked to CPT properly. Are they using lots of unspecified dx ? Payers look at all that.Also if pt has real beh health problem refer to BH therapist or after a time days(beh health problems on visits or year $ totally or capped) might be used up. CPT 99401-99404 for diet obesity use dx E66 or Z68 blocks and must be in record for the day. Whereas CPT 99406-99409 is for sub abuse drinking and smoking but not use the unspecified dx .Patient treated for a chronic conditions like dx E11, I10, N18, M10 ,J44 Etc linked to Eval mgnt codes and obesity abuse dx blocks linked to CPT 99401-99404. Oh yes cannot code health assessment( CPT 96156-96170) same time use CPT 99401 -99412) series on same claim
I hope helped you
Lady T
 
We are also having issue with these codes. Colon Rectal Specialist recently started using the 99401-99404/UPMC claims are denying stating Services not provided by network/primary care providers. I spoke to a provider rep and was told this is not used for specialists. Please provide insight on these codes and where to find correct information
 
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