brendagibbs
Guest
Hello. I live in AZ and we have state Medicaid (AHCCCS). I have a question regarding dual (or more) insurances and billing E&M codes.
I have patients that have private insurance (i.e. BCBS/UHC/Cigna) as primary and Medicaid as secondary. Do I use the E&M code (i.e. G0108) that I know the primary will reimburse or use the Medicaid E&M code (i.e. 99211/99354) in case the primary sends to secondary?
For example, I have a diabetes nurse provider and use code G0108 (DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 MINUTES) if they have private insurance. If the patient has Medicaid, I use codes 99211 (EST PT 5 MIN NO PHYSICIAN REQUIRED, SYNCHRONOUS TELEMEDICINE SERVICE RENDERED) and 99354 (PROLONGED SERVICE FIRST HOUR , SYNCHRONOUS TELEMEDICINE SERVICE RENDERED).
But in the case where a patient has both insurances, do you use the E&M that you know private insurance will cover or use the E&M that Medicaid will cover?
Thanks!
Brenda G
I have patients that have private insurance (i.e. BCBS/UHC/Cigna) as primary and Medicaid as secondary. Do I use the E&M code (i.e. G0108) that I know the primary will reimburse or use the Medicaid E&M code (i.e. 99211/99354) in case the primary sends to secondary?
For example, I have a diabetes nurse provider and use code G0108 (DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 MINUTES) if they have private insurance. If the patient has Medicaid, I use codes 99211 (EST PT 5 MIN NO PHYSICIAN REQUIRED, SYNCHRONOUS TELEMEDICINE SERVICE RENDERED) and 99354 (PROLONGED SERVICE FIRST HOUR , SYNCHRONOUS TELEMEDICINE SERVICE RENDERED).
But in the case where a patient has both insurances, do you use the E&M that you know private insurance will cover or use the E&M that Medicaid will cover?
Thanks!
Brenda G