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Denial for counseling

Tonya Posted Thu 02nd of September, 2010 12:11:08 PM

received denial on counseling for rabies exposure....used CPT code 99402 and V01.5. EOB says denied for primary diagnosis or service code listed. What should I do to get this paid? I believe the code 99402 should not have been used due to the fact the patient is not a NEW PATIENT. But what CPT code and Should I have used V04.5? (Patient is an established patient)...

Thanks

SuperCoder Answered Thu 02nd of September, 2010 13:20:48 PM

The denial is due to using a problem code with a preventive counseling code. Instead use an office visit code with V01.5 provided the patient was exposed or thought she had come into contact with rabies.

V04.5 is for an immunization for rabies. You would use V04.5 with a rabies vaccine code and the counseling is included in the immunization administration code.

You can use the coundling risk factor reduction codes regardless of the patient's status as new or established. These codes, however, are for patients with no signs, symptoms, or diagnoses made relating to the counseling. Many insurers do not accept these codes. For these payers, when a physician, NP, or PA provides the counseling, you are better off using the office visit code. Since counseling comprises the entire encounter in this case, you would select the appropriate EM code based on the time CPT indicates is typically associated with that level of service. For a 30 minute visit of an established patient, you would use 99214 (25 minutes).

Jen Godreau, CPC, CPEDC
Content Director, SuperCoder.com

Tonya Posted Thu 02nd of September, 2010 13:37:36 PM

Thanks a million!

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