Q0011

How would you properly code 99213, 99386 and Q0091. We keep getting denials. I have done some research and it said that Q0091 was greater than 99213. Any help you may give in this matter would be greatly appreciated. Thanks Ann

re: Q0011

Many carriers do not recognize the Q0091 because it is a Medicare specific code or the carrier will often bundle the Q code into the wellnes code. An E/M may be reported if the service is over and above the wellness visit. Some carriers will pay for one but not the other (usually the lower fee, even with the modifier 25) with the logic that the patient is either well or sick but not both. Separate documentation should be done when reporting both wellnes and E/M, but again many carriers will only pay one E/M. Check with your carriers about the Q code. In Louisiana, BC/BS will not pay for either the Q code or the E/M when billed with the wellness. Oh, and remember that if the carrier pays for both E/M codes they will charge a co-pay and then you will have an angry patient saying that he/she came in for a wellness visit and do not pay a co-pay. Lynn Kimsey, CPC, CPMA, CPC-I, CEMC