T1003 and 99213

[EBurleyStill]

I bill for a behavioral health facility.  There was a client seen for a nursing assessment, T1003 then had a telehealth service 99213GTU2 on the same day.

The Medicaid CMO paid the T1003 but denied the 99213.  Wouldn't these be similar services?  I want to verify before I pursue this.  It seems to me that you couldn't bill these together but I can't locate this in my books. 

I appreciate any advice!  Thanks

[Michele]

Well you can bill them but the question is whether or not they will be allowed separately.  However, if the telehealth session is separate from the nursing assessment (meaning the assessment was not being done solely to prepare the patient for the telehealth service) you may want to consider adding a 25 modifier to the 99213, if the patient's notes/chart warrant the 25 modifier.

[EBurleyStill]

Thank you, I'll try that.  I read the notes and they are unrelated.

[PMRNC]

Are these on same day? a Telehealth and then the patient came in? 99213 needs at least 15 min face to face. I do mental health as well and most carriers won't pay for both on same day. IF it's that the doc talked to patient on phone then patient came in, you could try a modifier but I'm thinking they are only going to pay the primary code.