Ray Posted Tue 03rd of July, 2012 21:52:10 PM
We billed a commercial carrier a well child check-up (99293) we also billed a seperate office visit 99213 along with a modifier 25 and cpt code 17250 (cauterization) with modifier 59 on the same day. The insurance carrier paid the 99213 and 17250 claim but denied the 99293 well child check up visit because they stated it was incidental or part of the surgical code which is the 17250 that paid. should we bill these two procedures on the same day or not?
SuperCoder Answered Wed 04th of July, 2012 06:50:59 AM
SuperCoder Answered Wed 04th of July, 2012 11:28:51 AM
The CPT Code 99293 is not a valid CPT code. As per given scenario it should be 99393.
As per NCCI edit there is no bundling between 99393, 99213 and 17250, so we can bill these three codes together; however in most of the case these combination will not get paid completely depending upon the medical necessity.
99393 & 99213: Billing these two codes together require separate medical necessity along with significant MDM.
99393 & 17250: It is ok to bill 17250 along with 99393.
99213 & 17250: It is also good to go.
Here I would like to share that Well child visit code (99393) is a pre-planned procedure and allowable visit depends upon the payer's policy (mostly once in a year), so the payer may denied this code based upon the nature of visit, medical necessity etc.
Also these combinations attract federal audit if billed to the Medicare.