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Medicaid

  1. #1
    Location
    Springfield, Mo
    Posts
    382
    Question Medicaid
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    I didn't get any takers in the E/M forum, so maybe Billing is a better place for this question. I have heard conflicting things about billing MCD (Mo.) and I hope someone can tell me the actual facts. I have been told that MCD will not pay an E/M code and a procedure at the same office visit, therefore we are only to bill one or the other. But I have also been told to code and bill whatever is documented regardless of what they will pay. Doing it that way has resulted in MCD not paying EITHER one. Does MCD have a rule that they only allow you to bill for one or the other? If so, do we get to choose which one?
    solocoder CPC

  2. #2
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    I am not aware of any edits like that. Are you using the correct modifiers? I would put a 25 on your e/m.

  3. #3
    Location
    Manhattan, NY
    Posts
    390
    Default
    It would help if you gave a couple examples of the combination CPTs you are using.... Are they bundled? Sometimes, our Medicaid carrier uses an alternate CPT code for some services.... Maybe this is one of those instances?

  4. #4
    Location
    Springfield, Mo
    Posts
    382
    Default
    It's just an e/m code (plus a-25) along with a procedure code such as 20550 or 11730. But this problem is only with Medicaid.
    solocoder CPC

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