Hi, I work for an FQHC and I am receiving multiple denials from our MCO's for "bundling" when I submit an EM level with any other code. Example, 99213 with 99406 (for smoking counseling), J3420 (B12), 90715 (Tdap) Doesn't matter what the providers have added to the claim, they deny for bundled services. I am so confused.
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Wiki FQHC Injections
- Thread starter varga1195@yahoo.com
- Start date
cjtown
Networker
Have you tried adding a modifier to the E/M? 
I have, they pay nothing on the claim. I thought 99406 was a legit HCPC
We are an FQHC and often bill with additional services beyond the E&M (ex: 99213-25, 96372, J1885, etc) and we are not denied for bundling. This may be an issue with a specific carrier. I would suggest taking this to the contracts division for additional assistance from the carrier on what is causing the bundling edit.
Being an FQHC does not change the standard billing rules. The only difference for the FQHC is the summary or core payments that we receive (ex: G0467 etc). Good luck!
Being an FQHC does not change the standard billing rules. The only difference for the FQHC is the summary or core payments that we receive (ex: G0467 etc). Good luck!
tg
Networker
Unrelated FQHC Question
I work for an FQHC too. We have a podiatrist who performs many procedures which are denied as uncovered since the procedures are considered routine foot care (nail trimming, nail debridement, corn and callus removal). Many of these encounters do not warrant an office visit in addition to the procedure code. Since we can only bill the rate code when an office visit is billed we are receiving no payment at all for many, many of our podiatry visits. Does this make sense? Are we missing something?
Thank you.
I work for an FQHC too. We have a podiatrist who performs many procedures which are denied as uncovered since the procedures are considered routine foot care (nail trimming, nail debridement, corn and callus removal). Many of these encounters do not warrant an office visit in addition to the procedure code. Since we can only bill the rate code when an office visit is billed we are receiving no payment at all for many, many of our podiatry visits. Does this make sense? Are we missing something?
Thank you.
Unfortunately you are not missing anything. That is one of the downsides to the FQHC world with Medicare. When procedures are performed and no E&M is warranted the service is considered Non-CORE and nothing is billable. The upside is that all FQHC providers are made "whole" at the end of the year when the numbers are calculated, but it is little disappointing for the individual account.
In addition Medicare will still follow the general benefit guidelines so often times even valid E&M services can be denied as a non-benefit. As you know Medicare does have restriction when it comes to podiatry services.
In addition Medicare will still follow the general benefit guidelines so often times even valid E&M services can be denied as a non-benefit. As you know Medicare does have restriction when it comes to podiatry services.
tg
Networker
It's funny to me how if the patient was seen for the same issue (fungal toenails, corns and calluses) but no procedure was performed, we could bill the office visit and get paid! Wouldn't it make more sense for the insurance to pay by diagnosis as opposed to procedure?