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98960, G0108, or 99211? Need help quick!

  1. #1
    Louisville Kentucky Chapter
    Unhappy 98960, G0108, or 99211? Need help quick!
    Clearnace Sale
    I was wondering if someone could help me with this little situation. We billed Medicare for 98960 for a patient that came in for Diabetes education. This was all that was done at this vist, nothing else was done. The RN MD was on site at time) spent 30 min. with the patient.

    I tried to tell the MD that this is a bundled code per Medicare, but she wanted me to submit it anyway, alone and see what they say. I did as instruced, and yes...they denied it as "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated." There was no other service, so there was no other bill they could adjudicate it with. She now wants me to submit it as a nurse visit, and do this for now, "until we can find someone who knows how to code this correctly". Apparently, the urgent unit that she helps at, does it all the time and they get paid for it.

    Yes, I am new at this, and we don't do this very often, but we want to do this for our patients more often so I need to know how to do it correctly so we can get paid for this service too. I did try to tell her in the begining I didn't think they would pay for it. So before I just submit it again, (possibly incorrectly) I'm asking for help in here. I saw another thread that suggested G0108. Since this is a Medicare patient, should I use this code then? Will that get us paid? We also used DX of 250.00

    I know 98960 will be denied, my question is, should I go with 99211 or G0108?
    Thanks for your help.
    Jeannie Geerts, CPC

  2. #2
    I would go with G0108 if they are there for Diabetes education
    Herbie W Lorona Jr., CPC, CPC-H

  3. #3
    Louisville Kentucky Chapter
    Thank you. I'll give that one a try then. I appreciate your help.
    Jeannie Geerts, CPC

  4. #4
    Louisville Kentucky Chapter
    I do want to thank you for your help on this.

    For those of you who might be interested...I did some more invistigating and found that in order to get paid using codes G0108 and G0109, our RN (who would be taking the time to do this) would need to be a certified diabetic educator.

    There is a great artical located on the AAFP site that talks about this.

    (I do hope it was okay to post this)

    So...because she is not certified in this, we are just going to submit 99211.
    Jeannie Geerts, CPC

  5. #5
    Does anyone know if it isn't a medicare patient and a nurse or pharmicists is doing any type of patient education what code you would use and get paid? Would you use 99211 or 98960.

  6. #6
    Columbia, MO
    we use 98960 and Medicare reimburses with no problem.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    thanks that is good to know.

  8. Default
    I have a query pertaining to 98960. I have information which states that code 98960 is staus B code, i.e Medicare does not pay for it, then how come for few of them medicare has reimbursed 98960 ? I need Help on this as i am expriencing denial for 98960 staing its a bundled code. a) I have only this code 98960 for the visit and it got denied.

  9. #9
    Anchorage, Alaska
    We have just run into this question as well. We are getting the CO-B15 denial saying that a qualifying service/procedure is required and M80 saying that it is bundled. This is the only service we are billing. The education was done by a staff RN and billed under the MD's Medicare provider ID. The code does not appear on the Fee Schedule. When I do a search on the MAC's website for code 98960, nothing is found. I notice that the dates of this discussion are 2010. Is this a code that used to be covered but is not any longer?

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