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Hello, All!
(Semi- new coder here! Be easy on me!
)- NP Primary Care office
I am currently servicing 20+ payers without issue at my current clinic, but when I DO have an issue regarding billing or denials, its almost always with Medicaid.
I recently found out that NPs can only use/only get paid for certain CPT/ICD-10 combinations with Medicaid (is what a claims rep told me the reason was for our constant denials).
We billed a 7 yr old a 99838 with a Z00.129 (Routine child health exam)- now, this is within the manual we were using (Updated July 2024), but apparently we were using the non-nurse practitioner version. I have downloaded and skimmed through the "Advanced NP" version, but find nothing really regarding an answer as to how we can get this service covered.
Note- this was a family that came in, ages ranged from 5-17 yrs of age, all had similar codes, with slight variations, but denials all came back the same.
Would this just be changed to a 99204/99203 as I don't see 99838s within the NP manual? Is it that easy? Only thing to rebuke this is that we did attempt this route already, but it was still denied, so I'm thinking its more so the ICD-10 code used?
We bill hundreds of patients and rarely have any issues, its just with Medicaid, so I'm desperately trying to find an answer.
Thanks, All!
(Semi- new coder here! Be easy on me!
)- NP Primary Care officeI am currently servicing 20+ payers without issue at my current clinic, but when I DO have an issue regarding billing or denials, its almost always with Medicaid.
I recently found out that NPs can only use/only get paid for certain CPT/ICD-10 combinations with Medicaid (is what a claims rep told me the reason was for our constant denials).
We billed a 7 yr old a 99838 with a Z00.129 (Routine child health exam)- now, this is within the manual we were using (Updated July 2024), but apparently we were using the non-nurse practitioner version. I have downloaded and skimmed through the "Advanced NP" version, but find nothing really regarding an answer as to how we can get this service covered.
Note- this was a family that came in, ages ranged from 5-17 yrs of age, all had similar codes, with slight variations, but denials all came back the same.
Would this just be changed to a 99204/99203 as I don't see 99838s within the NP manual? Is it that easy? Only thing to rebuke this is that we did attempt this route already, but it was still denied, so I'm thinking its more so the ICD-10 code used?
We bill hundreds of patients and rarely have any issues, its just with Medicaid, so I'm desperately trying to find an answer.
Thanks, All!