Author Topic: cpt 99396  (Read 406 times)

billspecial01

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cpt 99396
« on: February 19, 2018, 12:46:26 PM »
Hi my provider insists on doing more than one 99396 a year because if not her census will be low and she will get dinged at the end of the year. So we bill 99396 with a Z01.419(well woman) then within the same year about a month or two apart from the well woman visit we bill a 99396 again, this time with a Z00.00(physical). (Ins will deny a E&M code with a Z00.00). The first service usually gets paid while the second service is denied or they ask for Medical Records we submit them and then they deny it. She says it would be too much work to do them on the same day and wants me as her biller to figure out how to code it or what modifier to use to get the insurance to pay. Is this even possible? Medicaid as a rule will only allow one preventative care service a year! Please help.
« Last Edit: February 19, 2018, 01:05:17 PM by billspecial01 »

PMRNC

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Re: cpt 99396
« Reply #1 on: February 19, 2018, 02:25:08 PM »
Quote
Hi my provider insists on doing more than one 99396 a year because if not her census will be low and she will get dinged at the end of the year.

She has an ethical duty to do right by her patient's and not according to her "census". 

Quote
and wants me as her biller to figure out how to code it or what modifier to use to get the insurance to pay. Is this even possible? Medicaid as a rule will only allow one preventative care service a year!

Red flags should be going up as she never should ask you to figure out codes and modifiers to "get the insurance to pay" that is fraud. Coding is done based on HER documentation and what was actually done and documented it's not based on what insurance will pay. And that is correct Medicare will not allow more than one preventative care service a year.

Seems to me this doctor wants her cake and to eat it too and this is not good for her or for you as your just as responsible if you assign and bill out codes for the sake of reimbursement only.
Linda Walker
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billspecial01

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Re: cpt 99396
« Reply #2 on: February 19, 2018, 03:39:27 PM »
Thank you for the confirmation. No, I WILL NOT be assigning any codes or visits that did not occur. I haven't been billing for this provider for long  and Im not sure what her other billing company was doing. But I refuse to do it. Thank you for your help.