RE: Re: Supply/Demand, Chronic FU visits, coding coun...

[Guest guest]

I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though). I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis. Like lots of things, the key is knowing the insurance companies. It isn't the cpt as much as the icd9. United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit. They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment. In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5 weeks. I'd love to hear the call asking for an appt for insomnia. Others will pay me for the work. I'm starting a list of insurance company quirks and keeping it next to the computer where I do billing. I never would have known to do this with the previous system I worked under. .

[Guest guest]

I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though). I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis. Like lots of things, the key is knowing the insurance companies. It isn't the cpt as much as the icd9. United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit. They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment. In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5 weeks. I'd love to hear the call asking for an appt for insomnia. Others will pay me for the work. I'm starting a list of insurance company quirks and keeping it next to the computer where I do billing. I never would have known to do this with the previous system I worked under. .

[Guest guest]

I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though). I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis. Like lots of things, the key is knowing the insurance companies. It isn't the cpt as much as the icd9. United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit. They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment. In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5 weeks. I'd love to hear the call asking for an appt for insomnia. Others will pay me for the work. I'm starting a list of insurance company quirks and keeping it next to the computer where I do billing. I never would have known to do this with the previous system I worked under. .

[Guest guest]

United has denied mental health codes  with me also, but they always pay on appeal. I think it's a bad software glitch where the computer sees mental health together with a non- mental health provider. A couple of other companies do that too, but United is the only big one. I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   .

[Guest guest]

United has denied mental health codes  with me also, but they always pay on appeal. I think it's a bad software glitch where the computer sees mental health together with a non- mental health provider. A couple of other companies do that too, but United is the only big one. I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   .

[Guest guest]

United has denied mental health codes  with me also, but they always pay on appeal. I think it's a bad software glitch where the computer sees mental health together with a non- mental health provider. A couple of other companies do that too, but United is the only big one. I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   .

[Guest guest]

,I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as: 1. 311 Depression2. 401.9 Hypertensionsome insurers will deny it. If you reverse the order and resubmit as a new or corrected claim:1. 401.9 Hypertension2. 311 Depressionthey will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid. SetoSouth Pasadena, CAI generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   .

[Guest guest]

I agree

and I that is generally how I code the visits, but occasionally the patiens are

otherwise young & healthy & are only there for depression/anxiety,

etc. Sometimes the visit will still get paid by insurance but other times

they end up being self pays because the claim was denied.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5

weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

[Guest guest]

I agree

and I that is generally how I code the visits, but occasionally the patiens are

otherwise young & healthy & are only there for depression/anxiety,

etc. Sometimes the visit will still get paid by insurance but other times

they end up being self pays because the claim was denied.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5

weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

[Guest guest]

I agree

and I that is generally how I code the visits, but occasionally the patiens are

otherwise young & healthy & are only there for depression/anxiety,

etc. Sometimes the visit will still get paid by insurance but other times

they end up being self pays because the claim was denied.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5

weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

[Guest guest]

Along the same lines. I have been getting denied abut 80 % of the time using the the modifier -25. I have been trying to creatively figure out how to maximally, financially construct visits. Most of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25. For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit. Any thoughts at doing a better way? n Brock DO wrote: I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc. Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied. -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent: Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... , I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as: 1. 311 Depression 2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected claim: 1. 401.9 Hypertension 2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome"

because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid. Seto South Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though). I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis. Like

lots of things, the key is knowing the insurance companies. It isn't the cpt as much as the icd9. United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit. They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment. In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5 weeks. I'd love to hear the call asking for an appt for insomnia. Others will pay me for the work. I'm starting a list of insurance company quirks and keeping it next to the computer where I do billing. I never would have known to do this with the previous system I worked under. .

All-new Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

United and Cigna usually or always deny modifier 25 claims, even with a written appeal (United will change that in a miserly way in 2007).Most of my other insurers pay it, some, for instance BCBS routinely, others only after receiving a written appeal which includes a note that has separate sections for the preventive and E/M interactions. My practice is a little abnormal in terms of nationals stats, as about 1/3 of my patients are insured by a very powerful local HMO. Other folks could comment on the other big companies you may see.Along the same lines.  I have been getting denied abut 80 % of the time using the  the modifier -25.  I have been trying to creatively figure out how to maximally, financially construct visits.  Most of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25.  For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit.  Any thoughts at doing a better way?n Brock DO <drbrockrrohio> wrote:I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc.  Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied.  -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent: Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... ,I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as:  1. 311 Depression2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected claim: 1. 401.9 Hypertension2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid.  SetoSouth Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   . All-new Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

United and Cigna usually or always deny modifier 25 claims, even with a written appeal (United will change that in a miserly way in 2007).Most of my other insurers pay it, some, for instance BCBS routinely, others only after receiving a written appeal which includes a note that has separate sections for the preventive and E/M interactions. My practice is a little abnormal in terms of nationals stats, as about 1/3 of my patients are insured by a very powerful local HMO. Other folks could comment on the other big companies you may see.Along the same lines.  I have been getting denied abut 80 % of the time using the  the modifier -25.  I have been trying to creatively figure out how to maximally, financially construct visits.  Most of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25.  For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit.  Any thoughts at doing a better way?n Brock DO <drbrockrrohio> wrote:I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc.  Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied.  -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent: Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... ,I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as:  1. 311 Depression2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected claim: 1. 401.9 Hypertension2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid.  SetoSouth Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   . All-new Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

United and Cigna usually or always deny modifier 25 claims, even with a written appeal (United will change that in a miserly way in 2007).Most of my other insurers pay it, some, for instance BCBS routinely, others only after receiving a written appeal which includes a note that has separate sections for the preventive and E/M interactions. My practice is a little abnormal in terms of nationals stats, as about 1/3 of my patients are insured by a very powerful local HMO. Other folks could comment on the other big companies you may see.Along the same lines.  I have been getting denied abut 80 % of the time using the  the modifier -25.  I have been trying to creatively figure out how to maximally, financially construct visits.  Most of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25.  For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit.  Any thoughts at doing a better way?n Brock DO <drbrockrrohio> wrote:I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc.  Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied.  -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent: Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... ,I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as:  1. 311 Depression2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected claim: 1. 401.9 Hypertension2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid.  SetoSouth Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   . All-new Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

n,I don't know which insurers are denying your claims using modifier -25, but I have been paid by Blue Cross/Blue Shield and Aetna when I use -25. Like , I have been stiffed by United Healthcare and Cigna. I found this webpage which offered some helpful advice on how to get paid for a -25 visit: http://www.thecodingcenter.org/paper/10-01-a.htmlAnytime you submit a visit with a -25 modifier you need to submit a copy of the office note (if you don't submit the note the visit will be automatically denied).The exception to this rule is for New Patient and Consultation visits, which do not require the use of modifier -25, but if you do use the modifier, notes are not required.If the note is attached, your claim is sent to a nurse reviewer who based on certain criteria will determine if the visit is significant and separately identifiable. It will be paid or denied accordingly.The criteria was defined in this way, "once the usual services that are required of the procedure and the procedure itself are removed from the note (i.e. the necessary exam and affiliated services) ...do the remaining notes stand on their own and separately address the key components required for the reporting of that level of service?" If the visit is denied you have the right to request an appeal at which time the Medical Director gets involved in the review.Common reasons for denial are; the note doesn't meet documentation standards, the notes indicate the patient is returning for a continuation of treatment but no re-evaluation is done.I think I will try sending appeals with an attached office note and see what happens.  SetoSouth Pasadena, CAUnited and Cigna usually or always deny modifier 25 claims, even with a written appeal (United will change that in a miserly way in 2007).Most of my other insurers pay it, some, for instance BCBS routinely, others only after receiving a written appeal which includes a note that has separate sections for the preventive and E/M interactions. My practice is a little abnormal in terms of nationals stats, as about 1/3 of my patients are insured by a very powerful local HMO. Other folks could comment on the other big companies you may see.Along the same lines.  I have been getting denied abut 80 % of the time using the  the modifier -25.  I have been trying to creatively figure out how to maximally, financially construct visits.  Most of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25.  For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit.  Any thoughts at doing a better way?n Brock DO <drbrockrrohio> wrote:I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc.  Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied.  -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent: Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... ,I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as:  1. 311 Depression2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected claim: 1. 401.9 Hypertension2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 TMJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid.  SetoSouth Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though).  I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psychosis.  Like lots of things, the key is knowing the insurance companies.  It isn't the cpt as much as the icd9.  United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit.  They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment.  In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5  weeks.  I'd love to hear the call asking for an appt for insomnia. Others will pay me for  the work. I'm starting a list of  insurance company quirks and keeping it next to the computer where I do billing.  I never would have known to do this with the previous system I worked under.   . All-new Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

Those

-25 modifier rules you cite must be unique to your geographic area because my

UHC visits are almost always paid with the -25 modifier attached, except that I

rarely if ever code a preventive plus an acute visit on the same day. I

never submit office notes with the -25 modifier visits. I can sort of see

the resistance of some insurance companies to pay a preventive & acute

visit combined, because that can easily be abused. You know, someone is

in for a preventive visit but, oh by the way, their ear has hurt x 1 day so now

it is a preventive plus a 99213 for “otalgia”. To me that is

just part of the preventive visit. I guess in my mind I do not have a

clear distinction between preventives & acute visits because I still go over

all of those things like recommended age appropriate screenings, health

promotion, etc at most visits (not just preventives). That is probably

the main reason I rarely see people for a “routine physical”.

Also, medicolegally you will still be liable for all of the screening stuff,

health promotion, etc even if the patient was never seen for a

preventive.

But back to the -25, most all insurances

here recognize that for procedural stuff plus an E/M, except that Ohio Medicaid

automatically rejects all claims with that modifier.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a game, one in

which the insurance companies know the rules, but we don't. By trial and error,

I've figured out that some insurers won't pay for a visit if it seems solely

like a mental health or counselling visit. But if you place a non-psychiatric

ICD9 code as the top code, it does go through. For example, if you list your

ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order and resubmit

as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit for

" 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense

of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even see

an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new Yahoo! Mail - Fire up a more

powerful email and get things done faster.

[Guest guest]

Those

-25 modifier rules you cite must be unique to your geographic area because my

UHC visits are almost always paid with the -25 modifier attached, except that I

rarely if ever code a preventive plus an acute visit on the same day. I

never submit office notes with the -25 modifier visits. I can sort of see

the resistance of some insurance companies to pay a preventive & acute

visit combined, because that can easily be abused. You know, someone is

in for a preventive visit but, oh by the way, their ear has hurt x 1 day so now

it is a preventive plus a 99213 for “otalgia”. To me that is

just part of the preventive visit. I guess in my mind I do not have a

clear distinction between preventives & acute visits because I still go over

all of those things like recommended age appropriate screenings, health

promotion, etc at most visits (not just preventives). That is probably

the main reason I rarely see people for a “routine physical”.

Also, medicolegally you will still be liable for all of the screening stuff,

health promotion, etc even if the patient was never seen for a

preventive.

But back to the -25, most all insurances

here recognize that for procedural stuff plus an E/M, except that Ohio Medicaid

automatically rejects all claims with that modifier.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a game, one in

which the insurance companies know the rules, but we don't. By trial and error,

I've figured out that some insurers won't pay for a visit if it seems solely

like a mental health or counselling visit. But if you place a non-psychiatric

ICD9 code as the top code, it does go through. For example, if you list your

ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order and resubmit

as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit for

" 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense

of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even see

an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new Yahoo! Mail - Fire up a more

powerful email and get things done faster.

[Guest guest]

Those

-25 modifier rules you cite must be unique to your geographic area because my

UHC visits are almost always paid with the -25 modifier attached, except that I

rarely if ever code a preventive plus an acute visit on the same day. I

never submit office notes with the -25 modifier visits. I can sort of see

the resistance of some insurance companies to pay a preventive & acute

visit combined, because that can easily be abused. You know, someone is

in for a preventive visit but, oh by the way, their ear has hurt x 1 day so now

it is a preventive plus a 99213 for “otalgia”. To me that is

just part of the preventive visit. I guess in my mind I do not have a

clear distinction between preventives & acute visits because I still go over

all of those things like recommended age appropriate screenings, health

promotion, etc at most visits (not just preventives). That is probably

the main reason I rarely see people for a “routine physical”.

Also, medicolegally you will still be liable for all of the screening stuff,

health promotion, etc even if the patient was never seen for a

preventive.

But back to the -25, most all insurances

here recognize that for procedural stuff plus an E/M, except that Ohio Medicaid

automatically rejects all claims with that modifier.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

,

I've come to look upon medical claims coding as a game, one in

which the insurance companies know the rules, but we don't. By trial and error,

I've figured out that some insurers won't pay for a visit if it seems solely

like a mental health or counselling visit. But if you place a non-psychiatric

ICD9 code as the top code, it does go through. For example, if you list your

ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order and resubmit

as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit for

" 524.60 TMJ Syndrome " because they said they didn't cover dental

problems. I recoded it as " 388.70 Otalgia " (well, the chief complaint

was ear pain) and it went through. I'm sure there are others on the listserve

who have learned similar ways of " creative coding " . Still, it is

frustrating the amount of hoops and contortions we must go through in order to

be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense

of my abilities, so I treat lots of depression and the occasional mild

psychosis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even see

an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new Yahoo! Mail - Fire up a more

powerful email and get things done faster.

[Guest guest]

Do

those new patients actually say “I want a physical” or is that just

your interpretation of their reason for the “get established visit”?

My practice must be different because my patients almost never say “here

for routine physical.” If they come in to get established I code as a

99202-99205 I use the relevant problem based ICD-9 codes.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

! ,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 T! MJ Syndrome " because they said they didn't cover

dental problems. I recoded it as " 388.70 Otalgia " (well, the chief

complaint was ear pain) and it went through. I'm sure there are others on the

listserve who have learned similar ways of " creative coding " . Still,

it is frustrating the amount of hoops and contortions we must go through in

order to be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psych! osis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new

Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

Do

those new patients actually say “I want a physical” or is that just

your interpretation of their reason for the “get established visit”?

My practice must be different because my patients almost never say “here

for routine physical.” If they come in to get established I code as a

99202-99205 I use the relevant problem based ICD-9 codes.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

! ,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 T! MJ Syndrome " because they said they didn't cover

dental problems. I recoded it as " 388.70 Otalgia " (well, the chief

complaint was ear pain) and it went through. I'm sure there are others on the

listserve who have learned similar ways of " creative coding " . Still,

it is frustrating the amount of hoops and contortions we must go through in

order to be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psych! osis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new

Yahoo! Mail - Fire up a more powerful email and get things done faster.

[Guest guest]

Do

those new patients actually say “I want a physical” or is that just

your interpretation of their reason for the “get established visit”?

My practice must be different because my patients almost never say “here

for routine physical.” If they come in to get established I code as a

99202-99205 I use the relevant problem based ICD-9 codes.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

! ,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 T! MJ Syndrome " because they said they didn't cover

dental problems. I recoded it as " 388.70 Otalgia " (well, the chief

complaint was ear pain) and it went through. I'm sure there are others on the

listserve who have learned similar ways of " creative coding " . Still,

it is frustrating the amount of hoops and contortions we must go through in

order to be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psych! osis. Like lots of things, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare

will deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new

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[Guest guest]

If the patient is a male between 20 and 40 who "wants a physical" there is almost always an underlying fear. 311 has not been funded in my past.Try the series beginning with 29x.xx Brock DO wrote: Do those new patients actually say “I want a physical” or is that just your interpretation of their

reason for the “get established visit”? My practice must be different because my patients almost never say “here for routine physical.” If they come in to get established I code as a 99202-99205 I use the relevant problem based ICD-9 codes. -----Original Message-----From:

[mailto: ] On Behalf Of n Bobb-McKoySent: Tuesday, September 12, 2006 11:16 PMTo: Subject: RE: Re: Supply/Demand, Chronic FU visits, coding coun... Along the same lines. I have been getting denied abut 80 % of the time using the the modifier -25. I have been trying to creatively figure out how to maximally, financially construct visits. Most

of the patients I see for the first time come in as physicals, but end up having some issue, hence modifier -25. For females, I defer the gyn exam for a second visit and can also discuss lab work at that visit. Any thoughts at doing a better way? n Brock DO <drbrockrrohio> wrote: I agree and I that is generally how I code the visits, but occasionally the patiens are otherwise young & healthy & are only there for depression/anxiety, etc.

Sometimes the visit will still get paid by insurance but other times they end up being self pays because the claim was denied. -----Original Message-----From: [mailto: ] On Behalf Of Seto Sent:

Tuesday, September 12, 2006 10:20 AMTo: Subject: Re: Re: Supply/Demand, Chronic FU visits, coding coun... ! , I've come to look upon medical claims coding as a game, one in which the insurance companies know the rules, but we don't. By trial and error, I've figured out that some insurers won't pay for a visit if it seems solely like a mental health or

counselling visit. But if you place a non-psychiatric ICD9 code as the top code, it does go through. For example, if you list your ICD9 codes as: 1. 311 Depression 2. 401.9 Hypertension some insurers will deny it. If you reverse the order and resubmit as a new or corrected

claim: 1. 401.9 Hypertension 2. 311 Depression they will pay it. I had another insurer deny a visit for "524.60 T! MJ Syndrome" because they said they didn't cover dental problems. I recoded it as "388.70 Otalgia" (well, the chief complaint was ear pain) and it went through. I'm sure there are others

on the listserve who have learned similar ways of "creative coding". Still, it is frustrating the amount of hoops and contortions we must go through in order to be paid. Seto South Pasadena, CA I generally bill a 99213 or 99214 and am also doing other things at these visits (though sometimes not) and I do a ton of "mental health" visits. I'm sure you know since we are in the same geographic area, that there is a serious shortage of psychiatrists that take insurance (lots and lots of cash only though). I did a year in a psych residency and my husband is a psychiatrist so I'm sure I have an exaggerated sense of my abilities, so I treat lots of depression and the occasional mild psych! osis. Like lots of things, the

key is knowing the insurance companies. It isn't the cpt as much as the icd9. United healthcare will deny an entire visit if it has any icd9 even smelling like a mental health code. I had a girl I was treating for add and did her pap. They denied the entire visit. They also denied payment for insomnia, saying the patient needed to see a psychiatrist for treatment. In our area you can't even see an outpatient psychiatrist who accepts UHC for schizophrenia in the next 4-5 weeks. I'd love to hear the call asking for an appt for insomnia. Others will pay me for the work. I'm starting a list of insurance company quirks and keeping it next to the computer where I do billing. I never would have known to do this with the previous system I worked under. . All-new Yahoo! Mail - Fire up a more powerful email and get things done faster. "There is not in all America a more dangerous

trait than the deification of mere smartness unaccompanied by any sense of moral responsibility."Theodore RooseveltCertainly there is no hunting like the hunting of man and those who have hunted armed men long enough and liked it, never really care for anything else thereafter. Ernest Hemingway, "On the Blue Water," Esquire, April 1936US author & journalist (1899 - 1961)

Yahoo! Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

[Guest guest]

I

basically take care of all the “preventive” stuff as I go along

during acute visits & so there is really nothing new to discuss or work on

separately to justify a preventive/physical visit.  As I said before, you are medicolegally

obligated to discuss these preventive things whether the patient presents for a

physical or not.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

! ,

I've come to look upon medical claims coding as a

game, one in which the insurance companies know the rules, but we don't. By

trial and error, I've figured out that some insurers won't pay for a visit if

it seems solely like a ! mental health or counselling visit. But if you place a

non-psychiatric ICD9 code as the top code, it does go through. For example, if

you list your ICD9 codes as:

1. 311 Depression

2. 401.9 Hypertension

some insurers will deny it. If you reverse the order

and resubmit as a new or corrected claim:

1. 401.9 Hypertension

2. 311 Depression

they will pay it. I had another insurer deny a visit

for " 524.60 T! MJ Syndrome " because they said they didn't cover

dental problems. I recoded it as " 388.70 Otalgia " (well, the chief

complaint was ear pain) and it went through. I'm! sure there are others on the

listserve who have learned similar ways of " creative coding " . Still,

it is frustrating the amount of hoops and contortions we must go through in

order to be paid.

Seto

South Pasadena, CA

I generally bill a 99213 or 99214 and am also doing other things

at these visits (though sometimes not) and I do a ton of " mental

health " visits. I'm sure you know since we are in the same

geographic area, that there is a serious shortage of psychiatrists that take

insurance (lots and lots of cash only though). I did a year in a psych

residency and my husband is a psychiatrist so I'm sure I have an exaggerated

sense of my abilities, so I treat lots of depression and the occasional mild

psych! osis. Like lots of thing! s, the key is knowing the insurance

companies. It isn't the cpt as much as the icd9. United healthcare will

deny an entire visit if it has any icd9 even smelling like a mental health

code. I had a girl I was treating for add and did her pap. They denied the

entire visit. They also denied payment for insomnia, saying the patient

needed to see a psychiatrist for treatment. In our area you can't even

see an outpatient psychiatrist who accepts UHC for schizophrenia in the next

4-5 weeks. I'd love to hear the call asking for an appt for

insomnia. Others will pay me for the work. I'm starting a list

of insurance company quirks and keeping it next to the computer where I

do billing. I never would have known to do this with the previous system

I worked under. .

All-new

Yahoo! Mail - Fire up a more powerful email and get things done faster.

" There is n! ot in all America a more dangerous trait than the deification

of mere smartness unaccompanied by any sense of moral responsibility. "

Theodore Roosevelt

Certainly there is no hunting like the hunting of man and those who have hunted

armed men long enough and liked it, never really care for anything else

thereafter.

Ernest Hemingway, " On the Blue Water, " Esquire, April 1936

US author & journalist (1899 - 1961)

 

Yahoo! Messenger with Voice. Make

PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

[Guest guest]

I'm in the Columbus area too and I never never never get paid for a modifier 25 from UHC no matter what! I nearly always include a preventative screening code with a modifier 25 and the em code if I do a pe or pap and refill chronic meds, take care of other problems. I think I feel lucky I get paid when I do. I have to laugh , I get people saying they want a check up or a physical for nearly every appt, often when they have some real problem or concern.

[Guest guest]

I’m

not sure what I’m doing differently then. I do a fair amount of OMT

+ an E/M code on UHC patients and both parts are paid everytime, same with a

joint injection + E/M, lesion removal + E/M, etc. As for the physicals I

can not explain that except that people out here in London do not care about

healthy living, only acute care.

Re:

Re: Supply/Demand, Chronic FU visits, coding coun...

I'm

in the Columbus area too and I never never never get paid for a

modifier 25 from UHC no matter what! I nearly always include a

preventative screening code with a modifier 25 and the em code if I do a pe or

pap and refill chronic meds, take care of other problems. I think I feel

lucky I get paid when I do. I have to laugh , I get people saying

they want a check up or a physical for nearly every appt, often when they have

some real problem or concern.