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Post essure confirmation

  1. #1
    Exclamation Post essure confirmation
    Medical Coding Books
    I am getting mixed answers on the Post Essure Confirmation test (HSG) and how its being billed/paid. We typically bill as follows:

    99214-25
    58340 v67.09 v26.51
    74740 v67.09 v26.51

    When we bill, it typically goes towards the patient's surgical benefits, and they are stuck paying the deductible. According to ACA, the Essure procedure should be covered at 100%, in which it is when the device is implanted. We do not implant the Essure, we ONLY DO the confirmation test. I have had a few patients these last few weeks dispute their deductible amount, and state that it should be covered 100%. They are blaming the way that the procedure is being billed, however, again, when we verify, the carriers are telling us it hits deductible. Does anyone bill differently and have it covered for patients? Should we be adding a modifier (-33 maybe) to indicate that this is the confirmation???

    Any adivse on this is MUCH appreciated.

  2. #2
    Default
    Have you checked the Essure website, Essure.com, for information? They usually have a reimbursement section that explains how they think this should be billed. Not to say that is going to get the claim paid but I always reference the manufacturer's website when I have questions about their product. Hope that helps!
    Leandra Tufts, CPC, CPMA, CEMC, COBGC

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