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

[Guest guest]

I guess

some of this is just semantics. If a pt says they need a “check up”

but are really there for depression, ED, etc then that is not a preventive

visit & should not be coded as such. I guess I do it the other way

around. I see them for their acute concerns & address the preventive

items concurrently, mostly for medicolegal reasons. If you forget to

discuss & document a colon CA or prostate CA screening on a 50 yo male pt

& they are dx’d with it later, you will be sued regardless of whether

they have ever came in & requested a “physical”. So, by

the time someone comes to me for a physical I have most likely covered

everything & then there is nothing new to do. As you can tell, I’m

not a big believer in the benefit of an “annual physical” outside

the peds ages. Many studies have shown them to be ineffective at disease

prevention by themselves.

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.

[Guest guest]

There's been national articles about this United policy. They state that they never pay a 25 modifier when it's on a preventive visit with an E/M code also. I suspect that the 25 modifiers that are getting paid are when it's matched with a freeze or other surgical/technical procedure. According to AAFP's article about its negotiations with United, as of January 07, they will pay 50% of the E/M code submitted with a 25 modifier together with a preventive CPT code. Hurray, I guess.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]

There's been national articles about this United policy. They state that they never pay a 25 modifier when it's on a preventive visit with an E/M code also. I suspect that the 25 modifiers that are getting paid are when it's matched with a freeze or other surgical/technical procedure. According to AAFP's article about its negotiations with United, as of January 07, they will pay 50% of the E/M code submitted with a 25 modifier together with a preventive CPT code. Hurray, I guess.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 am very interested what you are doing to get lesion removal and E/M

paid together on UHC. Could you pull an EOB or 2 and post how that is

being coded and with CPT/ICD-9 codes.

UHC has not been doing this for us.

Inquiring minds want to know ;-)

rocky

--- Brock DO wrote:

> 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.

>

>

>

>

Rakesh Patel MD

Arizona Sun Family Medicine, P.C.

633 East Ray Road, #101

Gilbert, Arizona 85296

www.azsunfm.com

PLEASE NOTE: Email is not a secure form of communication. It should not be used

for urgent or sensitive messages. Email may be done securely through our web

portal. If you have a medical emergency go to an Emergency Room or call 911.

[Guest guest]

Yes,

that may be the case. I essentially never code a preventive & acute

E/M on the same day, & rarely do preventives (a handful per month maybe).

I will check re: other procedure + E/M + 25 modifier, but I’m almost

certain UHC pays these. Ohio Medicaid is the only one I’ve found

that rejects the 25 modifier claims.

Re:

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

There's been national articles about this United

policy. They state that they never pay a 25 modifier when it's on a preventive

visit with an E/M code also. I suspect that the 25 modifiers that are getting

paid are when it's matched with a freeze or other surgical/technical procedure.

According to AAFP's article about its negotiations with United, as of January

07, they will pay 50% of the E/M code submitted with a 25 modifier together

with a preventive CPT code. Hurray, I guess.

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]

Yes,

that may be the case. I essentially never code a preventive & acute

E/M on the same day, & rarely do preventives (a handful per month maybe).

I will check re: other procedure + E/M + 25 modifier, but I’m almost

certain UHC pays these. Ohio Medicaid is the only one I’ve found

that rejects the 25 modifier claims.

Re:

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

There's been national articles about this United

policy. They state that they never pay a 25 modifier when it's on a preventive

visit with an E/M code also. I suspect that the 25 modifiers that are getting

paid are when it's matched with a freeze or other surgical/technical procedure.

According to AAFP's article about its negotiations with United, as of January

07, they will pay 50% of the E/M code submitted with a 25 modifier together

with a preventive CPT code. Hurray, I guess.

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 do

not do preventives + acute E/M on same day, so that I am unable to comment

on. But just today I saw a lady for skin lesions, turned out to be

inflamed skin tags. My ICD-9 was 701.9, E/M was 99212 with -25 modifier

attached, followed by procedural codes 17000 & 17003 (cryo x 12 lesions

total). I assure you that both will be paid by UHC, they almost always

are. I’m not sure what you may be doing differently, different

geographic area, etc?

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.

>

>

>

>

Rakesh Patel MD

Arizona Sun Family Medicine, P.C.

633 East Ray Road, #101

Gilbert, Arizona 85296

www.azsunfm.com

PLEASE NOTE: Email is not a secure form of communication. It should not be used

for urgent or sensitive messages. Email may be done securely through our web

portal. If you have a medical emergency go to an Emergency Room or call 911.

[Guest guest]

I just remembered one critical difference. One of the big employers nearby is JP Chase, the other Cardinal Health. They both have chosen insurance coverage for their employees that allows for their preventative care to be covered at 100 percent while their acute care comes from a health care savings acct. the employer has funded. That's why they all call wanting physicals. Usually I get to the real issue in the first 30sec of the appt.

[Guest guest]

So, how

do you code those visits then, if they called for a physical but had another

actual reason for coming? To me, I would just address the problem &

bring them back later for the physical, rather than mess with the whole 25

modifier thing.

Re:

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

I just

remembered one critical difference. One of the big employers nearby is JP

Chase, the other Cardinal Health. They both have chosen insurance

coverage for their employees that allows for their preventative care to be

covered at 100 percent while their acute care comes from a health care savings

acct. the employer has funded. That's why they all call wanting

physicals. Usually I get to the real issue in the first 30sec of the

appt.

[Guest guest]

They actually say they want a physical. I am in a womens center, where most of my referrals are from. These women get their gyn care regularly, but don't have anyone to take care of "the rest of them"(quoted from a patient). Others have heard of the type of practice I have set up and since they haven't seen a doctor in a long time want a "complete physical." 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.

Get your own web address for just $1.99/1st yr. We'll help. Yahoo! Small Business.

[Guest guest]

I’m

only being somewhat serious, but what exactly is a “complete physical?”

How often does a head to toe exam really uncover anything that was not

previously symptomatic? Should it really take a doctor to say “you

need to get regular exercise, check your PSA, get a mammogram, etc?”

I guess that IS partially our role but a lot of that is almost lay-person level

knowledge these days. In other words, what 50 year old man these days does

not know about PSA’s & colonoscopies? Sure they need us to set

it up, but I do that now as part of regular visits.

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 r! ecoded 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.

Get your own web

address for just $1.99/1st yr. We'll help. Yahoo!

Small Business.

[Guest guest]

I agree that a " head-to-toe " exam is not too often needed. But I think I

do often catch something that had been missed previously during other

appts ... subtle heartburn x 10yrs that pt never mentioned uncovered

during a thorough ROS later found to have Barretts, a small bit of family

history that changes advise for screening, realizing that patient needs a

test and not clear why I'd not gotten them it before, etc, etc.

The trick is to have a system that allows you to note the priorities

during all " small " appts so screening and such is kept up to date.

Finally, research is quite clear that even for the " common knowledge "

issues (mammo, stopping smoking, colon testing, etc), a physician stating

outright " You should do such-and-such " leads to a statistically

significant increase in compliance. It's not 100% for sure but the

increase in compliance is much improved. Our words, even 30 seconds of

them, can have a great effect.

Tim

> I'm only being somewhat serious, but what exactly is a " complete

> physical? " How often does a head to toe exam really uncover anything

> that was not previously symptomatic? Should it really take a doctor to

> say " you need to get regular exercise, check your PSA, get a mammogram,

> etc? " I guess that IS partially our role but a lot of that is almost

> lay-person level knowledge these days. In other words, what 50 year old

> man these days does not know about PSA's & colonoscopies? Sure they

> need us to set it up, but I do that now as part of regular visits.

>

>

>

>

>

>

>

> 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 r!

> ecoded 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

> <http://us.rd.yahoo.com/evt=43256/*http:/advision.webevents.yahoo.com/mailbe

> ta> Yahoo! Mail - Fire up a more powerful email and get things done

> faster.

>

>

>

>

>

> _____

>

> Get your own web address for just $1.99/1st yr. We'll help. Yahoo!

> <http://us.rd.yahoo.com/evt=41244/*http:/smallbusiness.yahoo.com/>

> Small Business.

>

>

[Guest guest]

I agree that a " head-to-toe " exam is not too often needed. But I think I

do often catch something that had been missed previously during other

appts ... subtle heartburn x 10yrs that pt never mentioned uncovered

during a thorough ROS later found to have Barretts, a small bit of family

history that changes advise for screening, realizing that patient needs a

test and not clear why I'd not gotten them it before, etc, etc.

The trick is to have a system that allows you to note the priorities

during all " small " appts so screening and such is kept up to date.

Finally, research is quite clear that even for the " common knowledge "

issues (mammo, stopping smoking, colon testing, etc), a physician stating

outright " You should do such-and-such " leads to a statistically

significant increase in compliance. It's not 100% for sure but the

increase in compliance is much improved. Our words, even 30 seconds of

them, can have a great effect.

Tim

> I'm only being somewhat serious, but what exactly is a " complete

> physical? " How often does a head to toe exam really uncover anything

> that was not previously symptomatic? Should it really take a doctor to

> say " you need to get regular exercise, check your PSA, get a mammogram,

> etc? " I guess that IS partially our role but a lot of that is almost

> lay-person level knowledge these days. In other words, what 50 year old

> man these days does not know about PSA's & colonoscopies? Sure they

> need us to set it up, but I do that now as part of regular visits.

>

>

>

>

>

>

>

> 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 r!

> ecoded 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

> <http://us.rd.yahoo.com/evt=43256/*http:/advision.webevents.yahoo.com/mailbe

> ta> Yahoo! Mail - Fire up a more powerful email and get things done

> faster.

>

>

>

>

>

> _____

>

> Get your own web address for just $1.99/1st yr. We'll help. Yahoo!

> <http://us.rd.yahoo.com/evt=41244/*http:/smallbusiness.yahoo.com/>

> Small Business.

>

>

[Guest guest]

Most of my pts are trained to request a

CPE every year (all women, men >40). About 1/3 of the time, we find something

new (skin lesion that needs treatment, enlarged thyroid, etc.). That’s

also the time I have them do some annual questionairres, like PHQ9 for

depression, CARE vital signs for pain, feelings, medication side effects, etc

so that also uncovers ‘new’ (to me) issues that need to be

addressed.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of Brock DO

Sent: Thursday, September 21, 2006

8:14 AM

To:

Subject: RE:

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

I’m only being somewhat serious, but what exactly is a

“complete physical?” How often does a head to toe exam really

uncover anything that was not previously symptomatic? Should it really

take a doctor to say “you need to get regular exercise, check your PSA,

get a mammogram, etc?” I guess that IS partially our role but a lot

of that is almost lay-person level knowledge these days. In other words, what

50 year old man these days does not know about PSA’s &

colonoscopies? Sure they need us to set it up, but I do that now as part

of regular visits.

-----Original

Message-----

From:

[mailto: ]

On Behalf Of n Bobb-McKoy

Sent: Wednesday, September 20,

2006 11:20 PM

To:

Subject: RE:

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

They

actually say they want a physical. I am in a womens center, where most of

my referrals are from. These women get their gyn care regularly, but

don't have anyone to take care of " the rest of them " (quoted from a

patient). Others have heard of the type of practice I have set up and

since they haven't seen a doctor in a long time want a " complete

physical. "

Brock DO

<drbrockrrohio> 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-McKoy

Sent: Tuesday, September 12, 2006

11:16 PM

To:

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 t! he

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:@! yahoogroups.com] On Behalf Of Seto

Sent: Tuesday, September 12, 2006

10:20 AM

To:

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 r! ecoded 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.

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[Guest guest]

Most of my pts are trained to request a

CPE every year (all women, men >40). About 1/3 of the time, we find something

new (skin lesion that needs treatment, enlarged thyroid, etc.). That’s

also the time I have them do some annual questionairres, like PHQ9 for

depression, CARE vital signs for pain, feelings, medication side effects, etc

so that also uncovers ‘new’ (to me) issues that need to be

addressed.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of Brock DO

Sent: Thursday, September 21, 2006

8:14 AM

To:

Subject: RE:

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

I’m only being somewhat serious, but what exactly is a

“complete physical?” How often does a head to toe exam really

uncover anything that was not previously symptomatic? Should it really

take a doctor to say “you need to get regular exercise, check your PSA,

get a mammogram, etc?” I guess that IS partially our role but a lot

of that is almost lay-person level knowledge these days. In other words, what

50 year old man these days does not know about PSA’s &

colonoscopies? Sure they need us to set it up, but I do that now as part

of regular visits.

-----Original

Message-----

From:

[mailto: ]

On Behalf Of n Bobb-McKoy

Sent: Wednesday, September 20,

2006 11:20 PM

To:

Subject: RE:

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

They

actually say they want a physical. I am in a womens center, where most of

my referrals are from. These women get their gyn care regularly, but

don't have anyone to take care of " the rest of them " (quoted from a

patient). Others have heard of the type of practice I have set up and

since they haven't seen a doctor in a long time want a " complete

physical. "

Brock DO

<drbrockrrohio> 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-McKoy

Sent: Tuesday, September 12, 2006

11:16 PM

To:

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 t! he

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:@! yahoogroups.com] On Behalf Of Seto

Sent: Tuesday, September 12, 2006

10:20 AM

To:

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 r! ecoded 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.

Get your own web

address for just $1.99/1st yr. We'll help. Yahoo!

Small Business.