Wiki CODING NEW PT VISIT WITH OBESITY COUNSELING (99204 & 99402)

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riverside23

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I am new to coding and can not find "clear" guideline on billing new patient office visit with obesity counseling.

I billed 99204 and 99402-25. BCBS paid the new pt visit but denied the obesity counseling. I used dx code E66.9 for cpt code 99402. Can anyone give insight to what may be wrong??
 
Without knowing what the denial reason code/message is it is almost impossible to answer your question.

Any time you are asking for help understanding why something was denied or not covered it is best practice to include the denial reason code/message. You'll find you get your answers much quicker if those of who are trying to respond have all the information from the outset. Some people will just skip responding to your post because of the time it takes to respond to ask you for the additional information. The easier you make on us to answer your questions, the more likely you are to get responses. 😁
 
I do apologize! The denial code that I am getting back is Reason Code: 204: This service/equipment/drug is not covered under the patient's current benefit plan. There are times with Medicare I get denial code 96: Non covered charges.
 
It sounds like the patient's insurance plan doesn't cover obesity related services/treatment. You may need to contact the insurance company to confirm whether the plan has benefits related to treatment of obesity or of there is an exclusion for these services. If it is excluded from overage there is nothing, you can do to get it covered by insurance. If your remit from the insurance company shows it is patient responsibility, then you just need to bill the patient for the service.
 
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