Wiki Consultation coding issue.

Create Wiki
K

kahodges

Networker
Messages
27
Best answers
0
Hi all! *waves*

I am having a bit of an issue. Apparently because Medicare no longer accepts consultation codes such as 99204, certain commercial plans are following suit.

The office I work for (a private practice) uses this code frequently, and we've been having trouble getting reimbursed for the last month. Does anyone know the new code or modifiers that replaces 99204?

Thanks in advance!

-K
 
kahodges said:
Hi all! *waves*

I am having a bit of an issue. Apparently because Medicare no longer accepts consultation codes such as 99204, certain commercial plans are following suit. The office I work for uses this code frequently, and we are having trouble getting reimbursed for the last month. Does anyone know the new code or modifiers that replaces 99204?

Thanks in advance!

-K
Click to expand...

99204 is not a consultation code; it is for a new patient visit. What exactly is the denial? Has the patient been seen by the same provider (or another in your office in the same specialty) within the last 3 years?
 
You are correct; our office uses 99204 for new patient visits (or patient's who have not been to our office in 2+ years). Apparently, when I called the patient's insurance company, they said they recognize the code as a consultation, and will not reimburse.

She was a patient that came to our office about five years ago. To my knowledge, she hasn't seen any other practitioner of a same specialty since then.
 
kahodges said:
You are correct; our office uses 99204 for new patient visits (or patient's who have not been to our office in 2+ years). Apparently, when I called the patient's insurance company, they said they recognize the code as a consultation, and will not reimburse.

She was a patient that came to our office about five years ago. To my knowledge, she hasn't seen any other practitioner of a same specialty since then.
Click to expand...

That's an odd denial. Is this a major commercial payer? Do they have that in writing?
 
mhstrauss said:
That's an odd denial. Is this a major commercial payer? Do they have that in writing?
Click to expand...

I've been googling around for it, but can't find anything about that in the CMS website, and haven't heard of it until I got on the phone with this rep (about half an hour ago).

It is a weird denial- but I've been getting denials from BCBS the last month for that particular code. The patient in question has a regional commercial plan.

Maybe there's a new patient visit code I don't know about? *scratching head*
 
Ahh I completely forgot about this post (in the midst of CPC training)!

I ended up finding out what the problem was- 99204 was getting bundled with other CPTs, and I ended up having to add modifier 25 (to 99204) in these cases.
 
You must log in or register to reply here.
Top