Author Topic: Blue Cross E/M code  (Read 1666 times)

adenisem

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Blue Cross E/M code
« on: June 12, 2013, 01:26:15 PM »
I am billing for a psychiatrist in CA that is in-network with Blue Cross. Recently, I've been having an issue with the code 99213. Blue Cross is paying this as specialist instead of mental health stating that its a medical code not mental health for medication management. Every other insurance pays this code as mental health with no issues. Is anyone else having this issue?

Thank you.

PMRNC

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Re: Blue Cross E/M code
« Reply #1 on: June 12, 2013, 01:32:21 PM »
Are you using the proper add-on codes for psychotherapy or med management? as of 2013 there are E/M codes that have to be used in conjunction with the proper E/M code for prescribers.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

adenisem

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Re: Blue Cross E/M code
« Reply #2 on: June 12, 2013, 02:09:53 PM »
No, I haven't used any add on codes for 99213 sine most of the patients are stable, quick med. management checks. Should I be using an add on code?

PMRNC

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Re: Blue Cross E/M code
« Reply #3 on: June 12, 2013, 03:21:00 PM »
If you were using 99213 prior, and they were as you say "stable" and quick med management checks.. you were always using wrong code to begin with. You want to look at your M0064. You should not be using the E/M for JUST quick med check at all.
You also would only use the psychotherapy add-on codes if psychotherapy is being performed with the med check. Carriers are starting to flag these to catch JUST the quickie med checks which should NOT be used as E/M unless all supporting documentation for the E/M is met.

This is a good article on replacing 90862 and documentation.    BUT remember if NOTHING else is being done but a quickie med check M0064 is correct code.
http://icanotes.com/sites/default/files/pdfs/How%20To%20Document%20a%2099214%20E%26M%20Code.pdf
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com