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

re: Billing

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

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

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.