Smoking Cessation & Annual Depression

[TXBiller]

Hi All

I don't understand why our smoking cessations and annual depression screenings are not getting paid.  Below is an example of one of our claims with both but I can have different claims where 99406 is on it without G0444 and vice versa and they still do not get paid.

Can someone help me figure this out please?

99204  G71.00   R53.83   F17.210   F43.23
99406  G71.00   R53.83   F17.210   F43.23
G0444  G71.00   R53.83   F17.210   F43.23
90756  G71.00   R53.83   F17.210   F43.23
90471  G71.00   R53.83   F17.210   F43.23

[Michele]

Are all of the codes being denied?  What is the denial stating?  Some plans simply don't cover them but I'm wondering if all codes are being denied and what the denials are.

[TXBiller]

Before I send off the claim, I use a code scrubber that is built into our software.  More times than not, the dx for 99406 does not meet medical necessity.  The example I listed it did it to that one.  I can't figure out why it says that bc I thought the dx was good.

[Michele]

G71.00 is for muscular dystrophy.  I'm not s a certified coder but I wouldn't think that would be a covered dx for smoking cessation. 

Claims scrubbers are a great resource but cannot always tell you what is going to be covered.  Especially with a service such as smoking cessation.  In my experience not many insurances cover it.  At least they weren't up to a year or so ago.  IMO it should be covered, because it would cut down on medical issues, but they never ask me my opinion.     I would recommend calling and asking for benefits and asking if it is covered for the dx's that the provider would be using.