Wiki extended time

[Slraheb]

Hi,
My provider billed a 99205 with a 99417 and Blue Cross paid the 99205 but denied the 99417 stating "V74 Clinical edits applied on this service. Payment is included in another charge" The provider did spend the extra time and I did send notes in showing this but they denied it again for the same reason. Anyone come across this and how did you appeal this? Your help would be greatly appreciated

 

[sls314]

Hi,
My provider billed a 99205 with a 99417 and Blue Cross paid the 99205 but denied the 99417 stating "V74 Clinical edits applied on this service. Payment is included in another charge" The provider did spend the extra time and I did send notes in showing this but they denied it again for the same reason. Anyone come across this and how did you appeal this? Your help would be greatly appreciated

I usually have good luck getting BCBS to pay after submitting documentation. (I code for Radiation Oncology. Usually when I bill prolonged services, there are multiple metastases and other complicating diagnoses.)

BCBS has an ICD-10-CM list of diagnoses that may be medically appropriate for prolonged services. It looks like there might be a change coming to that list on 10/1, just from a quick google search now?

What diagnoses were on your claim? Some commercial payers will push back if the documentation doesn't support why the prolonged time was spent.

 

[Slraheb]

Hi, the diagnoses codes she used are C44.329 scc of other parts of the face and bcc of other parts of the face. I am going to try sending in documentation. Thanks for your help

 

[luvbuix]

have they adapted to Medicare requirements? for those you need more time beyond the upper number of the range.

 

[jkyles]

have they adapted to Medicare requirements? for those you need more time beyond the upper number of the range.

Good idea. Several payers do follow Medicare's rules and use G2212.