Wiki BCBS 99408

[cathy@goaoi.com]

Hello,

My providers are consistently trying to bill 99408 for bcbs commercial insurances for Alcohol Screenings.
If they do an alcohol screening and it is negative we are billing 99408 with dx Z13.89.
If they do an alcohol screening and it is positive we are billing 99408 with the applicable dx.
However, I am finding that no matter what diagnosis or modifier or result I use for BCBS they will not pay it. They keep bundling no matter if we bill with an OV only or an OV and Physical. Sometimes they tell us it is per their policy but don't give us a policy and then to look at our contractual agreement but that does not have anything on it and their fee schedules show 99408. So I am very confused.

I tried to tell the providers that to our research BCBS does not separately pay 99408 and it is considered included in the AWE and should be done at that time. However they insist there must be some other alternate code thing that BC will accept for alcohol screenings as they are advising patients about their alcohol intake and how it is affecting their medical conditions.

Is there an alternate code that is separately payable? Are we billing incorrectly?

 

[TThivierge]

Cathy
No not billing properly...why not use the sub abuse defiintive problem patient has or provider is checking on these issues...Dx F10, F12, F11, F19. The dx Z13 first is bad idea, use it as 2nd code. It seems like sequencing is the problem.
I hope helped you
Lady T

 

[cathy@goaoi.com]

Cathy
No not billing properly...why not use the sub abuse defiintive problem patient has or provider is checking on these issues...Dx F10, F12, F11, F19. The dx Z13 first is bad idea, use it as 2nd code. It seems like sequencing is the problem.
I hope helped you
Lady T

Our biggest issue is when it is negative. So the provider screens for alcohol abuse and finds that there is none. So the screening is negative. What code and diagnosis would I use for that screening for commercial? (for Medicare we use G0442) but commercial the providers have billed 99408 and of course there is no abuse diagnosis because the screen was negative. BCBS is denying them all.

 

[TThivierge]

Our biggest issue is when it is negative. So the provider screens for alcohol abuse and finds that there is none. So the screening is negative. What code and diagnosis would I use for that screening for commercial? (for Medicare we use G0442) but commercial the providers have billed 99408 and of course there is no abuse diagnosis because the screen was negative. BCBS is denying them all.

Cathy,
I d then use as first dx some description of dx blocks R44-R46 per provider s note. Maybe dx R44.8 and as 2nd dx be Z13.858 or Z13.31 or Z13.30. Or can try dx F99 or F09 Mental Health DO? If provider states in notations patient has been drinking or smoking I d use those dx. But provider must have some reason for billing this code & documentation should state it
Ok hope this data helped
Lady T

 

[MKuil1]

Our biggest issue is when it is negative. So the provider screens for alcohol abuse and finds that there is none. So the screening is negative. What code and diagnosis would I use for that screening for commercial? (for Medicare we use G0442) but commercial the providers have billed 99408 and of course there is no abuse diagnosis because the screen was negative. BCBS is denying them all.

This is what i've found:
"However, it is not appropriate to use this code if the provider determines that the patient does not require an intervention following the screening. In such cases, the screening should be included in the selection of an Evaluation and Management (E/M) or preventive service code instead."

https://www.codingahead.com/cpt-code-99408/