Wiki Billing E/M with a "routine dx"

[NikkiJaniszewski]

We are having issues with insurance companies not paying claims that we have billed with the appropriate level of E/M with contraception management. We have even used the v65.49 first with v25.01 and v25.9. We had a patient come in to discuss possibly getting a tubal sterilization. This was not her annual exam because it was time for her annual. There were no symptoms to code the only thing was the v25.9. Insurance company wont pay because they said we are billing a routine dx code with a problem visit procedure code. Any suggestions?

 

[kenkie79]

I don't know because the most I would likely do is call and send the notes. You have to bill those V codes unless the patient has some other reason that they want the sterilization. I don't usually have a problem with it. It might also depend on the insurance. Usually, if our patients are asking for sterilization, it's due to heavy periods.

 

[NikkiJaniszewski]

Thanks. The patient was here because her insurance covered the procedure 100% rather than her husband having a vasectomy. Her periods were normal 3-4 days light flow. Dr. documented that very clearly. Maybe it is the insurance? Medical Mutual.

 

[michelle417]

We have used preventative codes 99401-99404. These are preventative counseling codes. Unfortunately, if the patient has had their preventative visit within the same time frame, the insurance will deny for frequency and make it the patient's responsibility. Medical Mutual will not cover any V code with an E&M. You would have to use a preventative code