mforsyth

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I do billing for a provider who considers himself a weight management specialist. His primary method is a combination of medication and weight management counseling.
He also acts as a PCP for his regular patients, but his main priority is weight management.

When we bill insurance, we typically code 99214-99215 + 99401-99403. Of course, we use modifier -25 when using this code combination.
Lately we have been having trouble getting BCBS to reimburse us for the weight management counseling codes (99401-99404). We will get a denial on the EOB saying additional documentation/attachments are required to adjudicate this claim. So, we mail the medical records to BCBS with a medical attachment form, and we end up receiving a response letter saying:
The rules governing the reporting of more than one EM code for a patient on the same date of service have not been met, thus the use of modifier -25 should not allow the additional Evaluation and Management code to be reimbursed.... In addition, per CPT: Preventative medicine counseling and risk factor reduction interventions are for the purpose of promoting health and preventing illness or injury. Risk factor reduction service are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.
We tried billing 99215 + 99417 instead, but even 99417 gets processed as a noncovered charge 25% of the time.

BCBS seems to be the only insurance company we consistently have an issue with. We occasionally receive denials from other insurance companies, but they usual;;y get resolved when we submit the medical records.

Does anyone else code/bill for weight management specialists? What is the secret to consistently getting paid?

Thank you in advance!!!! :)
 
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