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V codes 1st listed

  1. #1
    Default V codes 1st listed
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    We were coding V25.xx as 1st (many time only listed) code for patient coming in for BC refills. Now insurance companies are denying this on E/M visits. Can anyone help me with this? Direction to documentation would be helpful.

    Example: patient comes in for BC refill, office notes state "no complaints" patient presents for refill of BC. The provider is selecting 99212 or 99213, they are doing a general exam and discussion, however, they don't have enough information/documentation to code to Well Visit.

  2. #2
    Columbia, MO
    It is a perfectly allowable code first listed. Many insurances consider birth control and those encounters for it to be patient responsibility. What does the denial state as the reason.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    I have requested the denial reason from our billing office.

  4. #4
    the denial given is "the procedure code we used indicates a problem focused visit and the DX is a routine visit DX"

    99213 with V25.40 was coded. ? should it be more specific on the V25.4x ie V25.41 or V25.49.

  5. #5
    Columbia, MO
    They are looking for a preventive E&M a visit for bc refill is usually in conjunction with a well woman encounter.

    Debra A. Mitchell, MSPH, CPC-H

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