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Is 799.2x is a billable code?

jabrb

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I've been told that I can't use 300.xx for billing as we are a pcp. I've been reading a lot of thread lately & I remember one of the thread suggest to use 799.2x instead of 300.xx

I've another one coming, I now use 879.8, 272.4, 401.1 & 799.21 for 99214-25 since the pt are having a phy (G0439). And I also use a 96116-59 with dx 799.21. Am I billing it correctly?
 

mitchellde

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Your combination of codes does not make sense.
you have a patient with multiple open wounds, unspecified, with an unspecified disorder of lipid metabolism , with unspecifed hypertension, and nervousness, then you want to code for an AWV, a level 4 visit and a neuro status behavioral exam. If the patient had an AWV then you use a V70.0 first listed, IF documentation can support then a separate exam for other reasons then you can POSSIBLY have the level 4 but if the patient indeed had multiple open wounds, the wounds will have precedence and you will need to reschedule the AWV and the mini mental exam. If this was due to a suicidal attempt then you need some other codes.
As far as using the 300.xx codes , yes they can be used but be certain the patient has actually been diagnosed with this condition, if so then you cannot use the 799.2x instead. some payers will not pay a family practice physician if a 300.xx code is first list, but then that does not make it an incorrect dx, it depends on the documentation.
The codes you have supplied however paint an illogical picture for an encounter. perhaps you could post the note.
 

jabrb

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We some times treat the pt with other issues while they come in for a AWV. But the bottom line is how can I bill for a pcp treating deprssion/anxiety attack, etc. What dx code need to be used in order to get paid?

Any info would be appreciated!
 

mitchellde

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Ok two issues... First if the patient comes in for an AWV then you cannot have a patient with multiple wounds. Also you chose an unspecified wound code, if they are being treated there needs to be better documentation or better codes. Also If the patient is having a "mini" mental exam then there is no room for a level 4 or an AWV. ICD-10 CM preventive visit codes do not allow for other diagnosis code to be used with them. It is best to get in the habit of an AWV being a wellness only visit.
If the patient has been diagnosed with clinical depression and your provider is following up and the payer does not allow for a PCP to treat mental diseases and disorders, then there is nothing you can do. You cannot change a patient's dx to get paid, that is wrong. If the patient has not been diagnosed with clinical depression, and is experiencing symptoms that are being trial treated, then the 799.xx codes are appropriate. But you must find out the truth here from the documentation, to code a patient with an incorrect dx can have serious side effects for the patient.
 
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