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Wiki Telehealth Denials For Modifier 95

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tlindo1

Networker
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Williams Bay, WI
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We are getting denials for our Medicaid telehealth services when billing E/M services 99212-99215 with modifier 95. Our system does not recognize the new codes 99804 - 99807 for telehealth services. Is this happening for everyone and how are you handling the denials?
 
You are getting denials because you have to use the new codes. Sounds like your practice needs to have their system updated correctly depending on the health plan policy. Code changes happen routinely, how is this normally done within your group?
Many/most EMRs have background settings where, depending on the plan attached to an encounter, the system will auto-change the code to the correct HCPCS or other code depending on rules within the system.
For example, I have seen where if a coder enters a CPT for a certain procedure, but the patient has Medicare, the system might automatically convert it to the required G code and that is what populates on the claim. Or, for certain libraries of codes, the procedure code library is different depending on the plan. This is usually background functionality managed by IT, etc.


 
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