Medical Billing Forum
Payments => Insurance Payments => : EBurleyStill December 12, 2018, 10:21:25 AM
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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!
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Are you billing those three codes together on the same claim?
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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!
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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?
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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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Hi,
Thanks for the update. The dx codes I've been given to use are: F902, F331, F332, F4310, F209, F3162 & F341.
I would like to get one more answer from you all so I can send the Doc an email asking whether he is providing therapy along with the e/m code & just not letting me know.
Detailed questions seem to unnerve him so I want to be as concise as possible.
Thanks so much!
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I'm assuming those diagnosis are not all on one claim? Can you break them out by E/M with diagnosis for each claim?
Also to better understand the denial for the E/M only (I'm stumped on the eval) you may need to contact Medicare to get further clarification of the denial. I think you also want to have the notes to be sure the appropriate level E/M is being used.
Another thing you could check are past claims for your 99213 and 99214 on same patient's. Go into the account and see how other claims are being billed and paid. I'm not seeing where a modifier would be needed at all. Some of diagnosis codes would be inconsistent if on same claim line but I think you were saying these are the diagnosis codes for all the denials together which is why It would be helpful to see them broken out. There is ONE other tiny thing...is the doctor using ICD-10 or DSM. I didn't look up all ones you posted but you want to make sure if billing Medcare he only uses ICD-10 as there are some differences (mainly with the more severe diagnosis)