Wiki RVU denials

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lojohn1422

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We are consider an internal medicine facility but focus on diagnosing and treating ADHD using a QB test. Our new pts come in and complete the QB test, rating scales and then spend at least an hour with the provider. Until recently, we were being reimbursed by insurance for all codes (99205, 96132, 96138, and 96110/96127) We have started getting the denials that due to RVU of 99205, the others are non covered. Does anyone have suggestions?
 
The nature of the codes themselves includes interpretation, evaluation and determining a plan of action. This would mean that you can't unbundle the E&M, as that work is included in the testing.
 
Pam Warren said:
The nature of the codes themselves includes interpretation, evaluation and determining a plan of action. This would mean that you can't unbundle the E&M, as that work is included in the testing.
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The QB testing and questionairres are not preformed by the provider and done completely seperate to the time with the provider. If we just went to a 99204, would that warrant us being able to bill them unbundled? We have to pay for the QB testing and we do not get reimbursed enough to cover the cost of testing if bundled
 
Are you billing the QB Testing under that provider? If not, they wouldn't bundle as they'd be on different claims under different provider NPI numbers.

Who is billing for the testing? Is it within the scope of their practice? Are you following incident-to guidelines? There's a lot going on here besides unbundling the testing.
 
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