Author Topic: Methotrexate  (Read 2110 times)

marciam

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Methotrexate
« on: September 03, 2009, 09:48:07 AM »
I need help!!!!!!!  help! help! help!

I am trying to bill methotrexate. I have been billing 99214, 25  96401 and J9250. I have a friend in the same specialty Rheumatology, and they pay her claims fine, although she's in ohio. I am in KY. I have tried to bill every way possible and it's denying for "diagnosis codes does not support procedure code billed", i have tried to bill 1,2,3 pointers, and every which way I know how. But they are still saying that i have to use codes 140-208 etc. for chemo, which we don't do chemo, we injected her knee. I have tried 714.0 715.96 and 787.02 and neither one will they accept. What do I have to do for Medicaid to pay this claim? It is fda approved!

Michele

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Re: Methotrexate
« Reply #1 on: September 03, 2009, 01:52:55 PM »
I had my answer until I read 'medicaid'.  If Medicaid doesn't cover it for the dx's then the only thing I can suggest is that you call Medicaid and ask to speak to someone in the Procedure Code Department.  Medicaid is a state program so it varies from state to state, but in NY they are very helpful in determining what is covered and what isn't and why.  It's worth a try.

Good luck
Michele
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PMRNC

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Re: Methotrexate
« Reply #2 on: September 03, 2009, 09:54:30 PM »
Yeah but they said they tried filing it several ways.. this to me is scary because it could cause them to put a flag on the provider.. you are not supposed to code a claim for reimbursement purposes.. billing something several times and changing codes/pointers..that all spells flags. 
Linda Walker
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marciam

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Re: Methotrexate
« Reply #3 on: September 21, 2009, 02:39:02 PM »
Actually, This was medicaid's idea to do it several ways, I was online w/ them while they tried to figure out why it didn't work. So what I did was contact the Medicaid office like Michele requested and spoke to someone who actually could find out what was wrong. They do recognize it but for Rheumatology to be accepted under this particular code, I have to submit a letter stating to add it under Rheumatolgy and not just cancer because it is FDA approved but i guess not many rheumatologist's use this code. But it is something we use for the office and therefore, billable and reimbursable. Thanks Michele!