Wiki medicaid reimbursement for office visits

[melissamarie221@hotmail.com]

I'm a coder and today I got a call from one of the billers saying that they got a letter from Medicaid asking for money back on office visits where patient had any kind of pulmonary diagnosis and had treatments in office for it. They are saying that these are bundled and that they are only going to pay for the $34 neb treatment and not the $138 office visit. As far back as 2011 they are asking for this, has anyone had this yet?

 

[lao1960]

Can you tell me what state you live in? Just wondering if it's going to be affecting us too.

 

[lburke31]

I live in va and got one that stated, "overpayment reason code narrative for the reimbursement of E&M services when the physician is performing a pulmonary diagnostic procedure scenario." the pt had a 99213 and a 94640 and a strep test. dx was asthma and pharyngitis. I have returned paperwork and encounter note to HMS and am in a pending stage. how can DMAS consider a neb treatment as diagnostic? puzzling. lburke