mforsyth
New
I do billing for a provider who considers himself a weight management specialist. His primary method is a combination of medication and weight management counseling.
He also acts as a PCP for his regular patients, but his main priority is weight management.
When we bill insurance, we typically code 99214-99215 + 99401-99403. Of course, we use modifier -25 when using this code combination.
Lately we have been having trouble getting BCBS to reimburse us for the weight management counseling codes (99401-99404). We will get a denial on the EOB saying additional documentation/attachments are required to adjudicate this claim. So, we mail the medical records to BCBS with a medical attachment form, and we end up receiving a response letter saying:
BCBS seems to be the only insurance company we consistently have an issue with. We occasionally receive denials from other insurance companies, but they usual;;y get resolved when we submit the medical records.
Does anyone else code/bill for weight management specialists? What is the secret to consistently getting paid?
Thank you in advance!!!!
He also acts as a PCP for his regular patients, but his main priority is weight management.
When we bill insurance, we typically code 99214-99215 + 99401-99403. Of course, we use modifier -25 when using this code combination.
Lately we have been having trouble getting BCBS to reimburse us for the weight management counseling codes (99401-99404). We will get a denial on the EOB saying additional documentation/attachments are required to adjudicate this claim. So, we mail the medical records to BCBS with a medical attachment form, and we end up receiving a response letter saying:
We tried billing 99215 + 99417 instead, but even 99417 gets processed as a noncovered charge 25% of the time.The rules governing the reporting of more than one EM code for a patient on the same date of service have not been met, thus the use of modifier -25 should not allow the additional Evaluation and Management code to be reimbursed.... In addition, per CPT: Preventative medicine counseling and risk factor reduction interventions are for the purpose of promoting health and preventing illness or injury. Risk factor reduction service are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.
BCBS seems to be the only insurance company we consistently have an issue with. We occasionally receive denials from other insurance companies, but they usual;;y get resolved when we submit the medical records.
Does anyone else code/bill for weight management specialists? What is the secret to consistently getting paid?
Thank you in advance!!!!