Wiki Bc/bs denial from 2012

[jeaner54175@yahoo.com]

Our billing office recieved a denial from Anthem Blue Cross/Blue Shield from a behavioral health claim with the DOS of 11/28/12. The cpt code used was 90806 with the following explaination: PROCEDURE CODE 90806 IS NOT HIPAA COMPLAINT AND RESUBMIT WITH CORRECT PROCEDURE CODE. I was not coding at that time and I have been trying to reference this code on various sites with no luck. Would anyone know if we would need to add a modifier AJ to it?

Thank you,

Lisa Nieft/CPC-A

 

[lorrpb]

90806 was a valid code in 2012, but it was deleted 1/1/2013 when the psych codes were revamped, so it is not a HIPAA-compliant code for DOS in 2013 and later. However, you should bill with the code that was in effect at the time the service was provided, which you did. You don't say when the claim was processed, but Anthem's system may not deal well with a claim from a past year with a code that has been deleted. I would suggest that you call Anthem, explain the situation to them, and ask how it can be corrected. It may be that they need to manually process the claim in order to override their system.