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CPE diagnosis code

Zakari Posted Wed 09th of November, 2011 18:07:51 PM

What is the diagnosis code for CPE?
- I am getting rejection for billing V70.0 for ages 16 and up.
- I billed V70.3 for age 15 and also got denied.
Thank you.

SuperCoder Answered Wed 09th of November, 2011 23:07:23 PM

If it is Medicare, then Medicare doesn't pay for CPT codes for CPE. Check the Insurance plz.

Zakari Posted Thu 10th of November, 2011 14:59:01 PM

The payor is Health Alliance Plan of Michigan (HAP) I used the CPT code 99213 and 99214 they are rejecting the diagnosis code V70.0 and V70.3. Thank you

SuperCoder Answered Mon 14th of November, 2011 19:16:07 PM

V70.0 normally goes with 99391-99397(for established patient).
If you are using CPT 99213, then please don't use ICD V70.0
Going by your question, I think the patient has come for a Routine Medical Examination. In that case, for an established patient, you should code V70.0 with CPT:
99394 for age 12 through 17 years
99395 for age 18-39 years
99396 for age 40-64 years
99397 for age 65 years and older

Zakari Posted Wed 16th of November, 2011 16:25:07 PM

What diagnosis code do I need to use with cpt 99394? V70.0 is for ages 18 and up.
Thank you.

SuperCoder Answered Wed 16th of November, 2011 17:08:55 PM


Zakari Posted Wed 16th of November, 2011 17:30:29 PM

The diagnosis code v70.0 is for ages 18 and up the cpt 99394 is 12-17. The patient is age 14. what is the diagnosis code for routine physical exam? thank you.

SuperCoder Answered Thu 17th of November, 2011 14:10:54 PM

Check the report.
If it is just the routine exam, you can code V70.8
But, if it is a routine exam for a specific reason like preadmission checkup for school, sports checkup, for summercamp then you can code V70.3
If it is part of routine health exam for school children or students, then V70.5
I understood your point, but most of the payers advise to bill V70.0 for which I advised so.

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