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G0447 AND E/M CODE

William Ivan Posted Tue 24th of June, 2014 15:24:45 PM

WE RECENTLY RECEIVED A DENIAL FROM A COMMERCIAL PAYOR ON THE G0447 WHEN BILLING WITH A 90214. INSURANCE REP CLAIMS THAT ACCORDING TO A CCI EDIT, G0447 SHOULD BE BUNDLED WITH A 99214. WE HAVE BEEN PAID BY MEDICARE IN THE PAST USING A G0447 AND A 99214. CAN YOU PROVIDE US WITH ANY GUIDANCE ON THIS DISCREPENCY. SOME OF THESE REPS ARE OF LITTLE HELP.
THANK YOU

SuperCoder Answered Wed 25th of June, 2014 04:41:30 AM

Face–to–face behavioral counseling for obesity, 15 minutes is covered by Medicare and most commercial insurers. Typically commercial payers will have their own guidelines for paying G0447 in addition to other office visits. Although Medicare still pays for these codes together, commercial payers may require a modifier on the G0447. Technically CCI does in fact bundle these two codes. It is important to check the commercial payer policy on this service and consider appending a modifier to G0447.

Thanks

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