Wiki 99406 routinely denied when billed with E/M

[JRhea0715]

MCR is denying the 99213-99215 or 99203-99205 but paying the 99406 when billed on the same DOS. We are only linking F17.210 to 99406, while our other dx are linked to the 99203-99205 / 99213 - 99205 code. We are ensuring the provider documents all necessary elements in order to bill the 99406. We have also tried adding modifier 25 to the 99203-99205 / 99213 - 99205 code, but we are still seeing denials. Any insight into this issue would be appreciated.

Here are two examples:
99204 w/ R60.0, I10, E11.69, I73.9 and 99406 w/ F17.210
99214 w/ I25.10, I48.0, I11.0, I73.9, I44.7 and 99406 w/ F17.210

 

[thranowski]

Have you tried appending modifier 25 to the 99406 instead?

If insurance considers tobacco cessation bundled into the E/M code, then you would want to raise the level of the E/M visit as needed to encompass the time spent on the tobacco cessation counseling.

 

[JRhea0715]

Have you tried appending modifier 25 to the 99406 instead?

If insurance considers tobacco cessation bundled into the E/M code, then you would want to raise the level of the E/M visit as needed to encompass the time spent on the tobacco cessation counseling.

No I haven't, I'll try that. Thank you!

 

[TenaWright]

You may also want to try using Z71.6 - Tobacco Abuse Counseling in your diagnosis codes. The time should also be clearly documented. Such as: "I spent 7 minutes in tobacco cessation counseling."

diagnosis codes, diagnosis coding

 

[JRhea0715]

You may also want to try using Z71.6 - Tobacco Abuse Counseling in your diagnosis codes. The time should also be clearly documented. Such as: "I spent 7 minutes in tobacco cessation counseling."

Thank you! I will try that. Adding the mod 25 to 99406 didn't seem to work... although it might be because I was using F17.210.

diagnosis codes, diagnosis coding