Wiki Coding/billing 99214 and 99406 on the same day...HELP!

[monikaelliott]

Why are all our patient insurances paying only the E/M and not smoking cessation 99406? It doesn't matter if I code as: 99214 & 99406 or 99214-25 & 99406 or 99214-25 & 99406-XU/59. I just cannot figure out why the smoking cessation codes 99406 or 99407 are not getting paid when billed with an E/M. Note: The only DX I am mapping to the smoking cessation CPT is F17.210

 

[TThivierge]

Hello Monikaelliott,
what was dx codes were mapped or linked to CPT 99214? Did you use dx F17.210 for both CPT of 99214 and 99406? CPT 99214 needs to be for supported medical condition of chronic problem patient has such as J44, E11, K21 as examples and may be a medication review or order lab testing or chest xray . But smoking cessation is discussion as preventive health type visit additional also need to add time spent on cessation of counseling on smoking, amounts of smoking and treatment plan. You could just bill CPT 99406 but documentation just be about only smoking cessation? Or just bill CPT 99214 but that is more for medical organ illness condition and maybe smoking too. You need to link CPT 99214 to medical conditions not just dx F17 alone. However it all depends on provider s documentation of smoking patient outcome, meds, time used on visit and extra chronic conditions reviewed & treated. Certain CPT are linked to certain diseases/diagnosis .
Well hope helped you somewhat in this problem.
Lady T

 

[amyjph]

Do they even cover the code? Did you check the payer policies? Are they looking for the G code? Do they allow an E/M to be billed with that on the same date? These are all things you have to look up.

 

[JRhea0715]

We're having the same issue. MCR is actually denying the 99213-99215 or 99203-99205 but paying the 99406. We are only linking F17.210 to 99406, while our other dx are linked to the 99203-99205 / 99213 - 99205 code. We have also tried all the modifier combinations that Monika noted. We are ensuring the provider documents all necessary elements in order to bill the 99406.

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

 

[feiteai@aol.com]

We're having the same issue. MCR is actually denying the 99213-99215 or 99203-99205 but paying the 99406. We are only linking F17.210 to 99406, while our other dx are linked to the 99203-99205 / 99213 - 99205 code. We have also tried all the modifier combinations that Monika noted. We are ensuring the provider documents all necessary elements in order to bill the 99406.

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

They’re bundling it together because your e&m level is too high. Also make sure you’re using the modifier 25 on your e&m as well as not using signs and symptoms as your primary dx. How you sequence your codes plays a major role in payment.

 

[JRhea0715]

They’re bundling it together because your e&m level is too high. Also make sure you’re using the modifier 25 on your e&m as well as not using signs and symptoms as your primary dx. How you sequence your codes plays a major role in payment.

Hi, thank you for your feedback. Are you saying that 99406 cannot be billed with 99214/99204/99215/99205? If so, do you happen to have a reference for this rule? I've scoured the web for this information but I'm coming up empty-handed. Thank you for your time! =)

 

[Cls1530]

We received denials on this when it is the first time the tobacco use has been documented and sent to insurance (insurance had no other record). We discussed with the patients and some of them have told their insurance companies they do not use tobacco in order to lower their cost sharing.