E/M Office Visit with G0436 Smoking Cessation to Medicare

[mah3434]

We are billing e/m such as 99214 with G0436 and Medicare is denying the 99214 stating CO50 medical necessity, M25 information doesn't support level of service and N386 denied based on NCD.

I called Medicare and the NCD they reference is 210.4.1.

I asked rep if it is due to DX and she said no the denials do not reference DX but the e/m and G0436 cannot be billed on the same day. I do not find this to be true in the NCD.

Does anyone have any insight? I read somewhere the e/m will need a modifier -25 but that doesn't seem to hold true on denial.

Example of billing
99204
1. M47817
2. M6281
3. M533
4. F17290

G0436
1. F17290

 

[suki_26]

We bill the G0436 also but make sure the DX for the G0436 is not in your E/M code
if you are only billing the 4 DX's listed bill your 99204 with DX's 1..2..3 and then the G0436 with DX 4
also add a 25 mod on the E/M
we are getting paid, hope this helps.

 

[mah3434]

Thank you!