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Thread: 99392 & 99212

  1. #1
    Join Date
    Apr 2007
    Location
    St. Louis
    Posts
    21

    Talking 99392 & 99212

    Sorry has been a while since I actually had to "code" code. One of our billing specialists has come to me a peds question:

    "...included cpt 99392 in with 99212, I had appealed this as there was enough evidence to support both charges. They are still denying this cpt as the documents do not support this service because it indicates a problem visit. Any idea why?"

    I was figuring the 99392 should've been billed & no need to address the problem-focused visit 99212 since it was addressed during the preventative.

    Feedback?

  2. #2

    Default

    did you have a -25 mod on the 99212?

  3. #3
    Join Date
    Apr 2007
    Location
    St. Louis
    Posts
    21

    Talking

    Don't know... will ask the biller.

  4. #4
    Join Date
    Apr 2007
    Location
    East Stroudsburg, PA
    Posts
    78

    Default

    Also, does the preventative have the V code for the diagnosis? The 99212 should be coded with the problem as the diagnosis code and the preventative should have the V code for the exam.

    It is possible to bill both codes. Also the insurance company may need a modifier of 25 on the 99212.
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

  5. #5
    Join Date
    Apr 2007
    Location
    St. Louis
    Posts
    21

    Talking

    Ok ladies,

    Biller informs me that: yes, V20.0 attached to the preventative 99392 & modifier-25 attached to the 99212.

    I have reviewed the transcription & covers both the physical exam & acute problem.

    ???

  6. #6
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,805

    Default

    Most payers will not tell you but will expect to see two visit notes one which address the preventative only and one which addresses the ov. In many EMRs you will need to close out one note and open another. Since essentially you are billing for two office visits the expectation is that the medical record will show two office notes. If the problem is addressed in the context of the preventive note then they have no motivation to recognise that the office visit is "significant and separately identifiable". Just the reason for denial that you cited leads me to think this may be the issue.

  7. #7
    Join Date
    Apr 2007
    Location
    St. Louis
    Posts
    21

    Talking

    Thank you, ladies, for your input. My biller has been informed.


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