Author Topic: E&M Code Bundled?  (Read 2416 times)

Christy

  • Sr. Member
  • ****
  • Posts: 278
E&M Code Bundled?
« 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!
« Last Edit: December 21, 2012, 03:26:22 PM by Christy »

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: E&M Code Bundled?
« Reply #1 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.

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: E&M Code Bundled?
« Reply #2 on: January 03, 2013, 12:20:41 PM »
thank you DMK.....NYS No Fault is a tough nut to crack!

Billergirlnyc

  • Full Member
  • ***
  • Posts: 107
Re: E&M Code Bundled?
« Reply #3 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 And go here for the book at Ingenix http://www.optumcoding.com/SearchResults.aspx?SearchTerm=%20%20nys%20workers%20comp%20fee%20schedule- it may be cheaper through the state. Hope that helps.
Don't worry. Be happy.
~Dalia, CPC, CPC-H, RHIT.

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: E&M Code Bundled?
« Reply #4 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! :)

Billergirlnyc

  • Full Member
  • ***
  • Posts: 107
Re: E&M Code Bundled?
« Reply #5 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.

Don't worry. Be happy.
~Dalia, CPC, CPC-H, RHIT.