Page 1 of 2 12 LastLast
Results 1 to 10 of 11

99406 denial for medicare

  1. Default 99406 denial for medicare
    New Call-to-action
    Good Morning, I work for an urgent care the doctor always bill 99213 and 99406 together and Medicare always deny the claim stating they can't be billed together. Can someone please help me. Thanks

  2. #2
    Cool Denial of CPT 99406 Weight Smoking Behavior Change Visits and office visit
    Hi M

    The insurance denial could be does the notation of the provider for the day reflect 2 diagnosis problems? Are the CPT codes linked to the proper dx codes? .For instance let us say the patient has HNT and CKD but doc is also monitor their BMI weight issue . The documentation MUST reflect the patient's problems and the weight problem. Are the dx codes Z71.3 weight management linked to 99406, plus adding a modifier 25 to the Eval Mgmt office visit. The BMI and E66 dx codes should be on the same claim but also the BMI % of the patient's should be noted in the medical record. And if the patient has BMI less than 30% it will not be covered...CMS regulation per the LCD info. If the patient has Medicare funding make sure use the proper G codes.

    Also you can check the payer's billing regulations because it may need pre-authorization and most payers only covers 6 weight management sessions a year.

    Ok I hope this information helps you

    Lady T

  3. Default
    Thank you. That helps a lot.

  4. Default Cpt 99406
    Quote Originally Posted by markita.scott@us.army.mil View Post
    Thank you. That helps a lot.
    Are you billing the office visit with Modifier 25 ? Also CPT 99406 look up the NCD 210.4.1 policy for the medically necessary ICD 10 codes.

  5. #5
    Default 99406- smoking cessation >3 min. Medicare denied
    Hi,

    Medicare denied all 99406 ( Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) codes with my e/m code. I stated the diagnosis code
    F17.200 - (Nicotine dependence, unspecified, uncomplicated) also with it and with 25 modifier. Please help me on it.

    Thanks

  6. #6
    Default
    Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.
    Carol Gaston CPC CRC CPCO

  7. #7
    Default 99406- smoking cessation >3 min. Medicare denied
    Quote Originally Posted by cgaston View Post
    Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.
    I am working in Pain management , so Medicare didn't allow 99406 with office visit? Does it comes under regular physicians office visit?

  8. Default
    Quote Originally Posted by cgaston View Post
    Medicare will only pay a total of 8 cessation counseling codes (99406 or 99407) per year; not per provider. If other providers have also billed for cessation your patient could have hit the maximum for the year.
    Do you just have to assume the patient has hit their maximum because it gets denied with an appropriate diagnosis code?

  9. Default
    "These are time-based codes and time spent with the patient must be documented in the medical record. When documentation supports that a significant, separately identifiable problem-oriented evaluation and management (E/M) service is rendered, the appropriate code for the E/M service may be reported separately. Append modifier 25 to the service code selected to indicate that a separately identifiable E/M service was provided on the same date of service as the counseling service." this notation came from my coding software. So, it looks like you need to add modifier 25

  10. #10
    Default 99406- smoking cessation >3 min. Medicare denied
    Quote Originally Posted by rsb2918@aol.com View Post
    "These are time-based codes and time spent with the patient must be documented in the medical record. When documentation supports that a significant, separately identifiable problem-oriented evaluation and management (E/M) service is rendered, the appropriate code for the E/M service may be reported separately. Append modifier 25 to the service code selected to indicate that a separately identifiable E/M service was provided on the same date of service as the counseling service." this notation came from my coding software. So, it looks like you need to add modifier 25
    My provider states that "Smoking cessation discussed with patient > 3 minutes", and I added 25 modifier too, and also checked that patient finished only 3 smoking cessation so still 5 cessions are remaining
    Then also Medicare denies all 99406, any more clarification please!

    Thank you.

Page 1 of 2 12 LastLast

Similar Threads

  1. Medicare Denial CO 97 and Denial CO 151
    By ednamerelmagill@gmail.com in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 03-15-2018, 07:17 PM
  2. Medicare denial of 95913 with denial n115
    By tinaleberte@yahoo.com in forum Medicare Regulations
    Replies: 0
    Last Post: 11-08-2017, 09:58 AM
  3. 99406 Inpt Medicare Advantage
    By adwood68 in forum Internal Medicine
    Replies: 1
    Last Post: 06-14-2013, 01:21 PM
  4. Medicare denial - Now Medicare paid but not for
    By nancy.anselmo@ccrheart.com in forum Cardiology
    Replies: 1
    Last Post: 04-11-2012, 02:58 PM
  5. Help with Medicare denial please?
    By ollielooya in forum Billing/Reimbursement
    Replies: 2
    Last Post: 03-07-2012, 03:33 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.