Wiki Claim Denials - Obesity Code Usage

[ljulien]

Looking for shared examples/resolutions to payer denials - (Commerical carriers only) (Non PCP) or E/M codes 99202-99205, 99212-99215 when 278.00-278.01is billed as a secondary diagnois on claims.

Obesity codes are being captured as a meaningful use measure.

In many of these cases, intermediate counseling is not provided, but the provider may recommend the patient lose weight, diet, nutrition screen.

Is anyone else experiencing denials from BCBS, Humana, etc? How have you handled this?

 

[mitchellde]

What is the denial reason? What other codes were billed?

 

[ljulien]

Good question (should have asked). I'm not on the billing side, but trying to assit. Will ask for that info and update the posting once received.

 

[clopez]

BMI (V85.0-V85.54) is one of the meaningful use core measures and if the ICD-9 codes are not sequenced correctly this may be causing your denial. What I have noticed is that the ancillary staff add the BMI code which defaults as the first listed Dx, I have instructed the providers to re-sequence the DX codes and assign the DX that they addresses as primary and BMI codes should be last. Obesity and Morbid obesity should be secondary to the primary reason if it's not the principal Dx addressed.