Wiki Preventive medicine codes and 17000

[E.L.]

Hello. BCBS has been bundling preventive medicine codes (99381-99387, 99391-99397) to 17000. I am not able to find their policy explaining how they should be bundled. Has anyone else had these denials?

 

[Skenyon]

BCBS Denials

We've also had denials on the preventive codes, when a "procedure" is billed for the same visit. The preventive services should not be denying and a call to our rep, said they were denying incorrectly and that we should call for adjustments. Such a pain!!!

 

[maddismom]

I'm assuming you are using Modifer 25? They definitely shouldn't bundle and I've not had any problems getting paid for both when using this modifer, but perhaps it's a new edit.

 

[Monika Liddle]

Double check that your diagnosis is linked correctly. You don't want CPT code 17000 linked to V70.0.

 

[E.L.]

Thank you for all your responses! The physical was filed with an office visit, so I had Modifier 25 on the office visit. The DX code was correct. It sounds like the best bet that I have is to contact the provider rep at this point.

 

[kana_gurl]

I have experienced this as well with HealthNet. We billed:
G0439 V70.0 - denied, "included in surgical package global"
99212-25 w/ 300.02, 782.3 paid
17110 782.3 paid

E.L, did you have any luck with your claim after contacting a provider rep?

 

[annwallace2394@gmail.com]

I, too have been having this issue except mine is with CCHMO. Denying incidental to procedure. Very frustrating. I have contacted CCHMO and they will not reverse their decisions. I charged a 99396 and 69210, total billed $240. CCHMO pd $20.21 TOTAL!!!

 

[cheermom68]

Since there is a procedure on the same day, both the G0439 and the 99212 need a 25 modifier. The G0439 was bundled with the procedure because you did not have a 25 modifier on it which would show that it was separate from the procedure.

99396 needs a 25 modifier when billed with 69210.