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mslori7

mslori7

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Local Chapter Officer
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69
Location
Evergreen Park, IL
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Hi,

can someone provide any assistance to me for a travel clinic question?

Scenario: The pt visits the Travel clinic to get immunizations and the nurse billed out a 99499 (unlisted E/M). Can we use the 99211 or is there another charge that we can use to get the claim paid. The 99499 is currently being denied and I personally don't think that this is right.

Thanks,

Lori
 
I would say if the patient saw the nurse and the nurse consulted with the patient, use 99211. It was a visit by the patient and it didn't require a physician then certainly use it!

What ICD-9 code did you use? I'm having problems with that...

Thanks and good luck!
 
If the patient is seen by a physician or NPP we code 99401-99402 for counseling on travel and discussing immunizations. Use V65.49 on 99401 and the appropriate immunization ICD-9 codes for the immunizations.
 
Self Pay

Our Travel Clinic is completely "self-pay in advance." Patients calling to inquire about an appointment are told this from the outset. Virtually no insurance company will reimburse for this "not medically necessary" service (i.e. the patient isn't sick). Billing to insurance was just delaying our reimbursement for too long. Patients are free to file the paperwork themselves and try to recoup their costs, but we do not bill insurance for our travel clinic visits at all.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
We are currently using V07.39 and insurance pays but from time to time (like now) I have a insurance company fight me on it. So I'm just wanting to make sure we use the correct code.
 
Blue Cross Blue Shield stipulates that even though a service is anticipated to not be covered, the service should still be billed to obtain a rejection. You can collect from the patient at the time of service, and an ABN should be signed and retained on the patient's record, for all insurances. Medicare has recommended the GZ modifier for these cases, which indicates a voluntary ABN was obtained at the time of service. This will automatically kick out on the front edits and reject faster.
 
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