Wiki billing and coding question

[kattykimm]

If patient has 2 insurances, you bill the first insurance - now sending to 2nd insurance company (with attached EOB of course) but they don't have this CPT code listed as a billable service - but there is a different code they use - Question: If we locate both billing codes on the note - can you legally change the billing code to bill the second insurance? If the 1st insurance doesn't pay anything and now trying 2nd insurance, is it legal only at this time to change the billing code? OR is it always illegal to change it. Some providers use HCPC codes for services or their own billing code while there is an equivalent is a CPT code at another insurance. Not sure what the legalities are with this. Some staff think that only one code can be used and you can never change it once it is billed at all. Thanks.

 

[tpontillo]

what code are we talking about?

 

[kattykimm]

H0004 - is a behavioral health code for Medicaid AHCCCS - versus counseling codes is a CPT code. Or does it matter which code?

 

[snjberry]

I know I bill hcpcs codes to medicare that I have to change for some of my second payers. Such as well woman codes.. However, I don't bill behavorial health. Sometimes you can call the payer and they will tell you if they accept changes. Thats what I did.

 

[gailmc]

I would agree that it is ok to convert a HCPCs code to an accepted code for the payer. We convert codes a lot because Medicare and two of our commerical payers do not accept consultation codes. We bill the consult initially and then if needed, convert it to an E/M if the secondary insurance does not accept consult codes. This can also happen for admin charges for flu, pneumo,and heb B shots for Medicare or Medicare replacement plans.