Wiki Billing 99391 WITH 99402

[scottc1]

I have a doc billing the above. The problem we are having is the insurance company is stating you cant bill these when its the same doc on same dos. No where in anything I found states this, but they have denied my appeal 2 times and Im not sure how to get them to pay. Thoughts?

 

[jennim920@yahoo.com]

Add Modifier

I would use modifier 25 to indicate they are seperate procedures, however you will most likely need to provide documentation that indicates the preventive medicine visit was seperate from the preventive counseling you performed.

 

[mitchellde]

I am agreeing with the denial. You are billing a preventive encounter for an infant less than a year old with a preventive counseling code. There is really no way for a physician to have a preventive counseling encounter with an infant. Counseling with the mother cannot be billed with this code

 

[scottc1]

preventative counseling

per the CPT book "the following codes are used to report the preventative medicine e&m of infants, children, adolescents and adults". Wouldnt this qualify to be billed for a 1 month old?

 

[mitchellde]

per the CPT book "the following codes are used to report the preventative medicine e&m of infants, children, adolescents and adults". Wouldnt this qualify to be billed for a 1 month old?

The instructions for the use of the 99402 does not contain the information you have posted, can you direct me to where in the CPT book you found this? I use the AMA version

 

[scottc1]

Thanks for responding. I found this on page 19 of the 2015 CPT book published by the AMA under Counseling risk factor reduction and behavior change intervention.

My supervisior says is "ok" to bill these 2 together and I disagree, but I need to back my mouth up before I say anything

 

[mitchellde]

Page 19 of my book is the consultation codes and that statement is no where there. However it is on page 35 under the preventive services heading which would cover your 99391 code but not applicable to the 99402 code. The instructions for the 99402 starts on page 36. You cannot meet the criteria for the use of that code with an infant.