AAPC - Back to school
Results 1 to 7 of 7

Thread: 99204-25

  1. #1

    Question 99204-25

    AAPC: Back to School
    We have recently started encountering denial from Medicaid for CPT 99204-25 when billed same day as nuclear stress test 78452, 93015. The denail reason is "5927 THIS PROC IS CONSIDERED INCIDENTAL TO ANOTHER PROC BILLED ON A HISTORY CLAIM". Is this accurate? We've never had this issue before.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If the stress test was already scheduled, even if the patient is a new patient you cannot charge the visit level since the evaluation to determine the necessity for the procedure was already done, even if by another physician they are not inclined to pay for this twice. Rarely are tests like a nuclear stress test performed immediately after examining the patient, they are almost always scheduled ahead of time. If you have the rare instance where the provider is seeing the patient for the first ime and makes a determination at that time a test is needed and it cannot wait to be scheduled then you can appeal with this information.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    We should schedule all new patients visits first and then have them come back for testing?

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    If the patient is referred to you for the purpose of the test then there is no way for you to bill for an initial office encounter. If you are seeing the patient for a problem and then determine that the test is necessary then you do not need to bring them back just appeal with the information that this was not a prior scheduled test.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5


    The only time I have seen that denial is when a patient is established and not a new patient. 99204 is for new patient visits only. Make sure patient is not established and if so, change 99204 to 99214. That denial is related to the office visit code and not the stress test most likely.

    Simone CPC, RHIT

  6. #6


    Not an established patient but it definitely is a Medicaid patient!

  7. #7


    Your next question is what is the limit amount of stress test Medicaid would cover. I checked with our OBGYN facility today and sure enough, that is the same denial that is received when a Mcaid patient has reached its maximum amount of ultrasounds. Two were billed prior which is the incidental found on a history claim.

Similar Threads

  1. 99214 and 99204
    By michelestr in forum Outpatient Facilities
    Replies: 2
    Last Post: 04-02-2014, 02:45 PM
  2. 92002 and 99204
    By kellyobenour@yahoo.com in forum E/M
    Replies: 0
    Last Post: 03-19-2014, 09:43 AM
  3. 99204 exam
    By grandmacora in forum Orthopaedics
    Replies: 3
    Last Post: 02-06-2012, 10:20 AM
  4. 99204-25 + 93015
    By amym in forum Cardiology
    Replies: 7
    Last Post: 08-30-2011, 10:56 AM
  5. use of E/M 99204
    By miriam j in forum Billing/Reimbursement
    Replies: 1
    Last Post: 07-23-2010, 10:07 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.