Question In Patient Psych codes denying for POS

[dallstar02]

I'm continually having in patient psych visits being denied by ChampVA for the place of service code. I'm filing 99222, 99223, 99232, and 99233 with place of service 51. Anyone else having any issue like this? I've called them a number of times and each time I get the same answer that it doesn't seem right and the claim is sent back through only to be rejected again. I've even asked to have it escalated to no avail. Any ideas anyone? TIA

 

[TThivierge]

Hi Dall
Here some questions to ask self causing the denials.....were they preapproved by Champus-Tricare? Ensure approval number from payer put on claim. Was a preauthorized treatment plan done first for each patient there? Are the LCSW ,LPC, and psychiatrist providers in the CHAMPUS Tricare network;credentialed ? The CPT codes seem ok but usually if psychiatrist or LCSW or LPC usually code 90791, 90792. 90832-etc. Are the diagnosis codes detailed or all unspecified dx? And any depression or substance abuse assessments done too linked with CPT 96127 or 96161 if necessary? I believe CPT 90791-90792 must be billed first then other CPT codes.
Well I hope helped you some what.
Lady T

 

[dallstar02]

LadyT: I'm filing these claim the same way we file every other in patient stay with every other insurer on the planet. ChampVA is the only one that seems to recently have a disconnect between the place of service and the CPT codes; I was really hoping to find someone else that had the same issue that had found some resolution. But I appreciate your help and your time and hope you have a GREAT day!!!