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E and M coding and vaccines

Deb Posted Fri 21st of March, 2014 12:24:15 PM

I need help in getting the 99397 paid for. ( the pt came in for a CPE and Cigna is denying that code but paid the rest)
'99397' DX code V70.0
'90736' DX code V05.8
'99213' I put a 25 modifier on this DX code 427.89
'93000' DX code V70.0
'90471' DX code V05.8

The insurance company paid the 90736,99213,93000,and the 90471 they denied the 99397 due to "this service is not allowed because it is part of a CMS NCCI column1/column2 edit.

SuperCoder Answered Tue 25th of March, 2014 16:29:29 PM

Ask your carrier about its policy on how to bill when you provide a Medicare covered, medically necessary service during the course of a comprehensive preventive examination. The formula your carrier uses to determine how much to bill the patient may differ slightly .

You should explain to your patients that they will be billed for the preventive examination, the portion not covered by Medicare/Insurance. This will be especially helpful if you have not billed a medically necessary service in conjunction with a preventive service in the past.

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