Wiki FQHC Billing Medical and Behavioral health with F DX on same day?

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nvelasquez@accelhc.org

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I am billing for a Federally Qualified Health Center (FQHC). Is one allowed to bill a medical visit and a behavioral health visit, with different F DXs, on the same day? Are we to receive reimbursement for both?
I am working with FirstCare Star and they only pay one or the other.
For example, the medical visit has CPT 99214 and diagnosis F43.10 (Post-traumatic stress disorder...). This claim was paid. The behavioral health visit has CPT 90832 and diagnosis F33.9 (Major depressive disorder...). This claim denied.
Any input or resources to use are GREATLY appreciated.
 
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Medicare just completed a webinar on FQHC billing payment and reimbursement. You should be paid for both on the same claim, but did you add the G codes for the visits? In the FQHC world they are the only pay line.
Example: Using your codes above
Revenue code 0521 FQHC est. pt. visit G0467 and 99214
Revenue code 900 FQHC est. MH pt. visit G0470 and 90832
Both should generate PPS rate. See pages 41-43 of the attached PDF from a previous workshop on FQHC billing.
FQHC PPS Coverage, Billing and Reimbursement (ngsmedicare.com)

Hope this helps.
Carla:cool:
 
Quick question regarding your revenue codes, what ehr system are you using? We are on ecw and it is not allowing us to change our rev codes. Any advice would be appreciated :)
 
Mhaycock89 said:
Quick question regarding your revenue codes, what ehr system are you using? We are on ecw and it is not allowing us to change our rev codes. Any advice would be appreciated :)
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I am not sure whom you requested information from, but we use Allscripts. The Revenue Codes are set from CMS, if you bill those services either RHC or FQHC the software should have them already loaded or somewhere were they can be loaded.
Our MAC is NGS and CMS, but the revenue codes are should be the same regardless, so I have copied Noridan's web version of them for you:
Carla :cool:
 
Mhaycock89 said:
Quick question regarding your revenue codes, what ehr system are you using? We are on ecw and it is not allowing us to change our rev codes. Any advice would be appreciated :)
Click to expand...
Hello, I work in FQHC and use eCW. You CAN change the revenue code from the insurance setting. Go into any patient's claim with the insurance, and click update. Then go to insurance billing info, UB setup, and add the revenue code you want to use for a specific CPT group. If you are not familiar with this process, submit a ticket to my ecw for technical problems. They will go through the process with you and set it up. Hope it helps
 
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