Forum - Questions & Answers

Sep 11th, 2014 - sschwartz 4 

New denials du eto PPACA guidelines

I recently got both a denial for one claim & Insurance (Regence BS) calling about another in which one patient was seen for birthcontrol the other to discuss a vasectomy. I was told due to the PPACA guidelines I am to use new codes but wasn't told what to use. The provider had coded 99213 with V25.09, so I tried rebilling with modifier 33 added. Would that be correct? Haven't got a response from insurance yet. Other scenerio is when it's an E&M, say 99213 with mixed diagnosis such as 388.70 and V25.09. I tried 99213 with 338.70 and modifier 25 and 99401 with V25.09 and Regence just denied the 99401 portion. However what I could find in writing seemed to say I can't have both DX with the 99213E&M as one is "preventive" and the 99213 is not. How do I now bill for this type of diagnosis combo? It used to pay fine.

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