Medicare denied 99204

I am new to billing for general practice (I can bill psych all day long) and I got a 99204 denial from Medicare "These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam." The Dx were V70.0, 272.0, 790.6, and 401.1. There were no other services performed this visit other than the 99204. I don’t understand why this was denied. Please help!

99204

99204 is an initial visit. It is one of the currently acceptable initial visits, but this is based on the same evaluation and management criteria as other visits, requiring reviewing body systems and problems with the patient. It is not a well visit. There is only one well-visit allowed for Medicare patients. V70.0 is a health exam, and the patient probably already has had the well-visit/check up. You need to call the telephone appeals line, have that code removed and the claim reprocessed, or resubmit the claim with the corrections. You want to remove that diagnosis and use the 272.0, 790.6, 401.9 diagnoses.

Thank you!

Thank you so much! I suspected that was the problem.