Bronchoscopy with conscious sedation and critical care

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Castle Rock, Colorado
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I've searched the threads for answers to my question and didn't find anything recent that was applicable.
We are a Critical Care & Pulmonary group, I have a provider who saw a patient and is billing 31646, 99152 and 99291-25, BCBS is only paying on 31646. There are multiple diagnoses on the claim. Can someone help me understand why they are denying the 99152 & 99291 when the diagnosis billed for those weren't all the same as what we billed for 31646.
 
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2
Location
Castle Rock, Colorado
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0
They could be looking for the Medicare code G0500 for Moderate sedation services provided with gastrointestinal endoscopic services instead of 99152

You must meet specific criteria to bill for Critical Care services. Here are the guidelines so you can see if the billed service did meet their criteria:

Thank you.
I'm pretty sure we met med nec criteria for critical care -- dxs J96.21, J80, C92/02, R57.8, J98.11, R06.02. The patient is 57, so not sure, but don't think it's a Medicare plan, but don't have access to verify that. I appreciate your input :)
 
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