Wiki established office visits for pain management

[NMURPHY8366]

Hello. I started working for a pain management center and they are getting denials for established visit code 99213 from Anthem TEA, stating that its not medically necessary. Is anyone else in the pain management world having this issue? and if so, how have you gotten your claims to go through and paid?

Does anyone have suggestions as to where I can get answers from in regards to this question?

 

[Melissa Harris CPC]

I have not come across this. Have you contacted the insurance? And if so what did they tell you?
If not, I would contact them and tell them this is an office visit. I am sure it is just an error.


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management

 

[NMURPHY8366]

Yes, they have stated that it is not medically necessary, but the patients are having an actual visit

 

[Melissa Harris CPC]

Unless the visit is within a global period for an RFA this shouldn't be the case. What diagnosis codes are you using?

 

[mitchellde]

Were there any other procedures coded at the same encounter?