Medical Billing Forum

Coding => Coding => Topic started by: Christy on December 21, 2012, 03:24:19 PM

Title: E&M Code Bundled?
Post by: Christy on December 21, 2012, 03:24:19 PM
Hi,

This is for an L.Ac. (non physician/chiropractor)

I need help. I bill acupuncture to NYS No Fault. For an initial visit we billed 99203-25  97810, 98711.

The 99203 was denied as part of the more comprehensive service?

This does not sound correct. It sounds like No Fault making up their own rules.... ::)

any insight/advice would be appreciated....

thanks!
Title: Re: E&M Code Bundled?
Post by: DMK on December 21, 2012, 04:01:17 PM
The new patient code (99203-25) is appropriate and should have been paid.  The doctor had to do an exam to determine what acupuncture to do.  He may not get paid for a re-eval, but the new patient SHOULD have been paid.  I would re-bill with initial exam notes.
Title: Re: E&M Code Bundled?
Post by: Christy on January 03, 2013, 12:20:41 PM
thank you DMK.....NYS No Fault is a tough nut to crack!
Title: Re: E&M Code Bundled?
Post by: Billergirlnyc on January 26, 2013, 02:11:59 PM
Hi Christy not sure if you're still having this issue, but please note that NYS No-Fault follows the rules of NYS Workers Compensation in terms of how they pay. I know it's odd, but trust me if you call and ask the carrier they'll tell you this. I would call NYS Worker's Comp Board and ask for the dept where you can order the book. Last time we ordered it was maybe $80 bucks, don't remember, and I don't have it in front of me to answer your question, but there is a book that's sold that goes over how they pay. I believe you can also order this book from Ingenix aka Optum, we just happen to order directly from NYS W/C Board.

Go here and go to the very last paragraph where it states NYS No-Fault uses Workers Comp pay scale and rules: http://www.dfs.ny.gov/insurance/r68/r68_art51.htm (http://www.dfs.ny.gov/insurance/r68/r68_art51.htm) And go here for the book at Ingenix http://www.optumcoding.com/SearchResults.aspx?SearchTerm=%20%20nys%20workers%20comp%20fee%20schedule (http://www.optumcoding.com/SearchResults.aspx?SearchTerm=%20%20nys%20workers%20comp%20fee%20schedule)- it may be cheaper through the state. Hope that helps.
Title: Re: E&M Code Bundled?
Post by: Christy on January 26, 2013, 02:30:27 PM
Thanks, Dee!  I have the NYS WCB book, but NYS WCB only covers acupuncture as performed by an MD or chiropractor....L.Ac.s are in no man's land...but NYS NF will cover acupuncture treatments, just not the initial visit....

you have been amazingly helpful today! :)
Title: Re: E&M Code Bundled?
Post by: Billergirlnyc on January 26, 2013, 02:51:25 PM
Thanks, Dee!  I have the NYS WCB book, but NYS WCB only covers acupuncture as performed by an MD or chiropractor....L.Ac.s are in no man's land...but NYS NF will cover acupuncture treatments, just not the initial visit....

you have been amazingly helpful today! :)

Awesome! I wasn't sure if they did, but for the acupuncturist group we bill for we never bill for OV unless it's to a commercial carrier. I loathe that the rules change from carrier to carrier and of course NF/WC.