Wiki 99406 routinely denied when billed with E/M

JRhea0715

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MCR is denying the 99213-99215 or 99203-99205 but paying the 99406 when billed on the same DOS. We are only linking F17.210 to 99406, while our other dx are linked to the 99203-99205 / 99213 - 99205 code. We are ensuring the provider documents all necessary elements in order to bill the 99406. We have also tried adding modifier 25 to the 99203-99205 / 99213 - 99205 code, but we are still seeing denials. Any insight into this issue would be appreciated.

Here are two examples:
99204 w/ R60.0, I10, E11.69, I73.9 and 99406 w/ F17.210
99214 w/ I25.10, I48.0, I11.0, I73.9, I44.7 and 99406 w/ F17.210
 
Have you tried appending modifier 25 to the 99406 instead?

If insurance considers tobacco cessation bundled into the E/M code, then you would want to raise the level of the E/M visit as needed to encompass the time spent on the tobacco cessation counseling.
 
Have you tried appending modifier 25 to the 99406 instead?

If insurance considers tobacco cessation bundled into the E/M code, then you would want to raise the level of the E/M visit as needed to encompass the time spent on the tobacco cessation counseling.
No I haven't, I'll try that. Thank you!
 
You may also want to try using Z71.6 - Tobacco Abuse Counseling in your diagnosis codes. The time should also be clearly documented. Such as: "I spent 7 minutes in tobacco cessation counseling."
 
You may also want to try using Z71.6 - Tobacco Abuse Counseling in your diagnosis codes. The time should also be clearly documented. Such as: "I spent 7 minutes in tobacco cessation counseling."
Thank you! I will try that. Adding the mod 25 to 99406 didn't seem to work... although it might be because I was using F17.210.
 
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