Billing > Billing
new mental health billing codes-25 modifier need?
James B:
That's good to hear. I have been resubmitting my 99213/90836(and similar) appointments with the 25 modifier on the first line ONLY for BC/BS because that is what someone from Anthem told my colleague to do. Has that been your experience? Prior to that, in at least one case, they paid the full amount on line one and completely ignored the therapy code.
With other insurers, in general, we have been seeing some improved reimbursements since the new codes took effect.
James B:
--- Quote from: rdmoore2003 on March 06, 2013, 12:57:00 PM ---
--- Quote from: rdmoore2003 on February 27, 2013, 06:41:14 PM --- I havent had issues with any except Blue Cross Blue Shield. They are not wanting E/M with therapy add on (90832, 90834 & 90837). We are waiting to see if they actually cover the E/M with medication add on (90833, 90836, & 90837)
--- End quote ---
BCBS is reimbursing the E/M + 90833, 90836, & 90838
--- End quote ---
I'm looking at an ERA indicating that they paid the first line(99214) in full but completely ignored the second line(90836). I'm going to have to call them.
PMRNC:
--- Quote ---That's good to hear. I have been resubmitting my 99213/90836(and similar) appointments with the 25 modifier on the first line ONLY for BC/BS because that is what someone from Anthem told my colleague to do. Has that been your experience? Prior to that, in at least one case, they paid the full amount on line one and completely ignored the therapy code.
--- End quote ---
Carriers are not supposed to tell you how to code and they should not be telling you to arbitrarily assign modifier 25, that's incorrect. Modifier 25 is ONLY for when there is "Significant separately identifiable E/M service by the same physician on the same day." Arbitrarily/routinely assigning this modifier is going to trigger a red flag. Where you assigned a modifier 25 I would hope documentation is going to show that it was a significant and separately identifiable service
rdmoore2003:
--- Quote from: James B on March 07, 2013, 03:36:25 PM ---
I'm looking at an ERA indicating that they paid the first line(99214) in full but completely ignored the second line(90836). I'm going to have to call them.
--- End quote ---
Blue Cross will not reimburse an E/M code with a therapy add on code. ex: 99214 + 90834 Blue Cross will reimburse E/M code with a medication add on code ex: 99214 + 90836
updastE:
<a href=http://stromectol.autos/>stromectol walmart</a> Patients rarely reported nausea, vomiting, or diarrhea as severe
Navigation
[0] Message Index
[#] Next page
[*] Previous page
Go to full version