• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki RVU denials

Create Wiki
L

lojohn1422

New
Messages
4
Location
Greensboro, NC
Best answers
0
We are consider an internal medicine facility but focus on diagnosing and treating ADHD using a QB test. Our new pts come in and complete the QB test, rating scales and then spend at least an hour with the provider. Until recently, we were being reimbursed by insurance for all codes (99205, 96132, 96138, and 96110/96127) We have started getting the denials that due to RVU of 99205, the others are non covered. Does anyone have suggestions?
 
The nature of the codes themselves includes interpretation, evaluation and determining a plan of action. This would mean that you can't unbundle the E&M, as that work is included in the testing.
 
Pam Warren said:
The nature of the codes themselves includes interpretation, evaluation and determining a plan of action. This would mean that you can't unbundle the E&M, as that work is included in the testing.
Click to expand...
The QB testing and questionairres are not preformed by the provider and done completely seperate to the time with the provider. If we just went to a 99204, would that warrant us being able to bill them unbundled? We have to pay for the QB testing and we do not get reimbursed enough to cover the cost of testing if bundled
 
Are you billing the QB Testing under that provider? If not, they wouldn't bundle as they'd be on different claims under different provider NPI numbers.

Who is billing for the testing? Is it within the scope of their practice? Are you following incident-to guidelines? There's a lot going on here besides unbundling the testing.
 
You must log in or register to reply here.
Top