Wiki Preventive medicine codes and 17000

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E.L.

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Hello. BCBS has been bundling preventive medicine codes (99381-99387, 99391-99397) to 17000. I am not able to find their policy explaining how they should be bundled. Has anyone else had these denials?
 
BCBS Denials

We've also had denials on the preventive codes, when a "procedure" is billed for the same visit. The preventive services should not be denying and a call to our rep, said they were denying incorrectly and that we should call for adjustments. Such a pain!!!
 
I'm assuming you are using Modifer 25? They definitely shouldn't bundle and I've not had any problems getting paid for both when using this modifer, but perhaps it's a new edit.
 
Thank you for all your responses! The physical was filed with an office visit, so I had Modifier 25 on the office visit. The DX code was correct. It sounds like the best bet that I have is to contact the provider rep at this point.
 
I have experienced this as well with HealthNet. We billed:
G0439 V70.0 - denied, "included in surgical package global"
99212-25 w/ 300.02, 782.3 paid
17110 782.3 paid

E.L, did you have any luck with your claim after contacting a provider rep?
 
I, too have been having this issue except mine is with CCHMO. Denying incidental to procedure. Very frustrating. I have contacted CCHMO and they will not reverse their decisions. I charged a 99396 and 69210, total billed $240. CCHMO pd $20.21 TOTAL!!!
 
Since there is a procedure on the same day, both the G0439 and the 99212 need a 25 modifier. The G0439 was bundled with the procedure because you did not have a 25 modifier on it which would show that it was separate from the procedure.

99396 needs a 25 modifier when billed with 69210.
 
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