Payments > Insurance Payments
Psychiatrist billing e/m to Medicare
EBurleyStill:
I am getting denials with Medicare for MD psychiatrist billing 99213, 99214 & 90792. They actually reject with MA130 that the claims are unprocessable because of incomplete info.
The other codes are N657, This should be billed with the appropriate code for these services & 11: The dx is inconsistent with the procedure.
Please tell me what I'm doing wrong! There must be some modifier I should be using. I bill for a psychologist & do not need modifiers, however he does not bill e/m codes. Also I do not think medicare accepts the "U" modifiers designating level of education. Am I correct?
I truly appreciate any guidance!
Michele:
Are you billing those three codes together on the same claim?
EBurleyStill:
No, the patient will have a 90792 on the initial visit, then each subsequent visit will either be a 99213 or 99214. I am billing from a remote location so I do not have access to his notes. All I have is what he gives me & they are all being denied for the reasons I stated.
Thanks!
Michele:
If you are billing only one code on a visit then no modifier would be appropriate. There isn't enough information to tell what is wrong with the claim. What dx is on the claim?
PMRNC:
Medicare doesn't like the 99213 with psychiatrists as most of patients going for med management are 99212. I agree with Michele that there just isn't enough info. Is he routinely doing 99213? What ICD-10 are you using. Is patient also getting psychotherapy? It could also be a frequency thing.. I know one of my psychiatrists was totally non compliant with coding when I came aboard and he would just charge the same 99213 on a bi-weekly case because he was doing therapy, then when new add-on codes he would omit them even if he was doing therapy. I had to have his notes to get him squared away and educate him.
To help more though we really would need diagnosis and clarification that the 99213 elements are all being met, especially if all your Medicare is being rejected for same reason.
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