Blue Shield Federal and Obesity/Dietary counseling gets very specific

My first post on obesity counseling can be found here. This is a very specific update to help you get paid a bit more. 

 

I have been running into problems with certain insurances. They have been bundling and excluding my G0447 and 99401 codes even though I am following my own guide. Blue Shield Federal and some Aetna plans are the most common offenders. Lengthy and boring story condensed, and, it turns out, these plans have specific exclusions for the diagnosis of Z68.30 to Z68.45. 

 

When I bill the claim with the Z code primary, the code gets denied stating the service is not a benefit. When I bill the claim with either E66.01 or E66.09 on the obesity counseling line item, and leave off the Z code entirely, those line items get paid. 

 

I also really suggest that if your system has pop-ups, alerts, built in claims edits, or anything along those lines that you utilize those for these specific situations. I know, personally, there is no way that I will be able to remember which specific patients or plans need these special rules without that tool. I do enough follow up as it is, I am not trying to make more for myself.  

 

One of the things that people often hire me for is an in-depth consult of an entire practice reviewing reports, procedures, and EOBs to help you make sure that you are keeping this type of money in your practice. I also have group and one-on-one training sessions to teach billers and managers how to do this themselves. Call me at (909) 610-9524 or email me at newgenerationbilling@gmail.com if you want to set something up.