Wiki billing for cpt 90801 w/dx 278.01

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gonzalezm27

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Can anyone help me? I can not seem to get any of our psychological
evaluations/consultions paid by BCBS. We are billing cpt 90801 w/dx 278.01 and keep getting denials stating our dx code is not compatible with cpt 90801. Our pt's are coming here on an oupt basis to get these psych evals done as a requirement from BCBS to qualify for bariatric surgery. I have gone back and forth with BCBS provider realtions people who tell me they will research the issue. We are having to appeal every single denial. We are a facility and bill with Rev code 900 with cpt 90801 & dx 278.01. Per BCBS the dx 278.01 is medical and therefore can not be billed with 90801. I just dont know what other dx code to use since the pt is only gettting this done because he/she is diagnosed as morbidly obese and its a BCBS requirement for bariatric surgery.
 
Not sure where you are but in Ohio, Anthem BC/BS made this is a requirement for the surgery but it is not a covered benefit. The patient is required to pay for the eval in full up front because the insurance won't. The insurance is still billed and in the rare case they do pay, the patient is then refunded.

Laura, CPC, CPMA, CEMC
 
We are located in Texas. When we obtain benefits for cpt 90801 with dx 278.01 we are told that the codes are valid and billable. Per BCBS cpt 90801 can NOT be billed with dx 278.01 due to cpt 90801 being a psych code. Per BCBS we must bill with a psych dx. So coverage/exclusion on pts plan is not the issue. When ever we appeal the denials they get paid. If BCBS is coming back and paying on these claims with out any changes on our part to the dx code 278.01 there is a serious issue with BCBS. I have filed a complaint with the Texas Department of Insurance regarding this issue. I just believe if its a covered benefit, and its a requirement mandated by BCBS, they should pay it and not make providers appeal these claims.

Thank You
 
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