Wiki Why can't I get this to pay?

[livingitupinok]

BCBS:

I can't get 99213 to pay with 81002(which is a waiver test) even if I add a mod 25.

Can anyone help me with this. It has become a thorn in my side!

 

[Melissa Harris CPC]

Have you appended the QW modifier?

I used to get denials because some BC plans do not cover this test. It was hit and miss

Melissa Harris, CPC

 

[livingitupinok]

I do not see on their modifier web page that you can add QW to BCBS claims. Am I worng on this? For some reason I have never used this code in coding commercial claims.

I tried to call Federal but they updated their system and said they could not tell me if it would pay. I dont want to have to call PPO,since it is so hit or miss with them, if you get someone who knows anything

 

[coding4fun]

you have to append the QW onto the lab code. We bill the following:
99213-25
81002-QW
Make sure that you are billing per carrier terms. For medicare they have LCD's for the labs and for Blue they typically follow Mcare rules.

Happy Coding!

 

[AKAJBART]

There aren't any CCI edits between these 2 codes. So if these are the only 2 codes being billed, then the OV shouldn't need a 25 modifier.