Wiki 99459

[ashleylowry]

I billed 99459 with a preventative code with dx Z01.419. Blue Cross of Alabama is stating it is a non-covered service because it is a routine/preventative exam. Everyone else I speak to is saying that are paying for them. Is anyone else having issues with this?

 

[csperoni]

99459 goes in the same department as G2211 and causing me more grey hair every day.
Some carriers will pay, some will bundle. Some will consider included in preventive, but pay when done with problem oriented visit. Some will pay at 100%, some will apply to deductible (even with preventive dx). Each carrier is setting their own policy.
From what I have seen (but your payors could differ) is probably about 70% will NOT bundle. However, we do keep seeing copays or deductible/co-insurance applied even when billed with preventive and Z01.419 dx. For those situations, we ask for re-processing under preventive benefit. When bundled (whether with preventive or 99202-99215), it is written off as payer contract adjustment.