Wiki georgia medicaid question

[julia9723]

A 3 year old comes in for a preventative visit and while there get a flu vaccine. We're billing a 99392 with a dx of V20.2. Medicaid is denying dx code is invalid for category of service. I called and the rep. said that V20.2 couldn't be used as a primary code. What would you suggest for a dx?

 

[jettman]

A 3 year old comes in for a preventative visit and while there get a flu vaccine. We're billing a 99392 with a dx of V20.2. Medicaid is denying dx code is invalid for category of service. I called and the rep. said that V20.2 couldn't be used as a primary code. What would you suggest for a dx?

Did your group rep suggest another code or give a reason why V20.2 wasn't valid?

This sounds to me to be a well visit and V20.2 is the most appropriate diagnosis code.

Perhaps your group rep is hung up the ICD-9 footnote for the V20 series footnote that says "these V codes may be used as principal diagnosis on Medicare patients"???

(My emphasis)

 

[pygreen]

Ga Medicaid

Are you appending Modifier EP to the 99392? V20.2 is a primary diagnosis only per the 2012 ICD-9 code book.

 

[julia9723]

No, we're not putting a EP modifier. If I do that, should it go through with the V code as the dx? Do I only use the EP modifier with medicaid and the medicaid HMO's?

 

[pygreen]

The EP modifier states that this is going through the HealthCheck for Medicaid program. It is only used for Medicaid and Medicaid HMO's.

If your provider is enrolled in the Healthcheck category of service for Medicaid, then the EP modifier most be appended for those services. If your doctor is not enrolled in the Health check program that it is not a covered service.