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99363 and 99364-I am stumped with

  1. #1
    Default 99363 and 99364-I am stumped with
    Medical Coding Books
    Hello All
    I am stumped with these two codes and billing for them. Our physician receives the lab reports and interprets them, makes a few phonecalls, etc.
    How do you code this?

    We have recently started using the new code 99364 but Medicare is denying them with this rejection message "Payment adjusted because this service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated."

    Can anyone tell me if they have received this message before? What are the actual fields that need to be filed in a CMS-1500 when billing for these services?

    Jessica, CPC

  2. #2
    Medicare (and most other payors) are not covering the 99363 and 99364 at this time.

    Consider billing an office visit code (99211 - 99215) if face-to-face visit.

    Here's a few articles on this subject:


  3. Default Anticoagulation Management
    Would it be appropriate to bill codes 99363 99364 when anticoagulation mgmt is performed by a pharmacist?

  4. #4
    Just a heads up, they are still denying these claims, we just had some come back to us.
    And we are trying to do what was in another post and Bill and Office Visit of 99211!

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