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  1. #1
    Unhappy G0463
    Medical Coding Books
    I have an account that got denied due to not being a covered code. I double checked and this is a valid code for the dos provided (2018). Then I was trying to see if this code had a LCD or NCD guidelines to see if this would help me out. I am AAPC coder and I am unable to find anything. Does anyone know any guidelines or LCD policies that have anything showing if they cover certain diagnosis codes? The Ins is Texas Medicaid.

  2. #2
    Are you billing for a hospital or for a physician? G0463 is a code for hospital billing only as it's a facility charge for the use of the clinic resources and is billed on a UB form. There are no LCDs governing this code, that I'm aware of and am not sure how Texas Medicaid handles this code. But if you're billing for a physician's services, this probably isn't the correct code and you should be using the appropriate CPT code to represent the E&M or other service provided.
    Thomas Field, CPC, CEMC

  3. #3
    Columbia, MO
    This is a code for outpatient facility services. Are you coding for the facility or the provider?

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default g0463
    I am billing for the provider.

  5. #5
    Columbia, MO
    Billing for the provider you will not use the G0463 at all. Use the appropriate CPT code for the E&M or any other procedure/service rendered.

    Debra A. Mitchell, MSPH, CPC-H

  6. Question G0463 denial
    Molina Centennial paid G0463 when billed by facility, and denied 99214 when billed by provider. My question is, does the G code replace the e/m code? Or can both be billed and reimbursed?

  7. #7
    Columbia, MO
    They pay both.. perhaps there was something else wrong with your claim for the 99214, what was your POS, what dx codes did you use.. what did the denial state?

    Debra A. Mitchell, MSPH, CPC-H

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