Forum - Questions & Answers

Apr 2nd, 2015 - vstuewe

Billing

Billing preventative code + E&M code same day + one or more procedures. I've had insurance companies pay the E&M and the procedure but not the physical code. Can you give me guidelines to billing this many things in one day for the best reimbursement? Thank you, Val

Apr 2nd, 2015 -

re: Billing

can you give an example of what your talking about please, thanks:)

Apr 2nd, 2015 -

re: Billing

99396
99213 25
11301
G8510

Or
99396
99213 25
94010
11300

Usually insurance considers the 99213 inclusive and pays the preventative code 99396, but in some cases when a procedure is added to the mix, they pay the lower priced 99213 and deny 99396.

Is there a way to bill to be sure the prev. code is paid or when there are procedures is it best to leave the E & M 99213 off?

Thank you

Apr 2nd, 2015 -

re: Billing

The reason that the insurance company is not payng the additional E&M 99213 is that it is inclusive of the preventive code 99396. The provider is already doing a exam of the integumentary system as part of the preventative medicine service, so why would you bill for the extra E&M service, it is not substanuated since hence you are removing the lesions that were found during the preventive services. I would code for the 99396 w/modifier 25 as this has higher RVU's and then for the procedure that was performed.



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