Category Archives: ICD10

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.  

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Filed under Aetna, Blue Shield, Denials, ICD10, Medical Billing, Obesity Counseling

ICD10

Hi guys. ICD10 starts in 10 days. Putting aside the fact that the giant database of diagnosis codes in my head will be useless at that point, too many of our doctors have stalled on getting ready and we are rushing to make sure everything is set up properly.

One of the things I DON’T need to rush to do is make sure my billing system is ready. I use Lytec and my amazing dealer, Advanced Data Management, has spent the last three weeks transitioning everything. I mean, I paid for it, but they called me to get things going. Anyone with Lytec, please call them. (909) 861-1357. Ask for Jo-Ann or Kelly. Here is the website:

http://www.adm1inc.com

I know that I don’t normally do plugs like this, but it is so important that you are all ready. If you end up having to put each of the new DX in manually, you are going to slow down to a CRAWL.And please be aware, if you have an EHR connected to your billing system, the charges are going to have issues coming over if your billing system does not have the ICD10 dx.

Good luck everyone! We are going to need it.

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Filed under Advanced Data Management, ICD10, Lytec

The new forms are here!

Hello everyone!

April 1st is the deadline to switch over to the new CMS forms. And that is today. I know that there are a lot of you out there following this blog,  so I have a quick public service announcement.

Please make sure you have the new forms for your paper AND electronic submissions today. If you are not sure whether or not you have the new forms, call around. Call your clearinghouse! Call your software vendor! Call MY software vendor! Call support! You may need to upgrade your software or re-map your print image file and test everything to make sure it’s working properly.

If you need help today, and you can’t get hold of  your support people, please do actually call my support people. I use Lytec and I get it from Advanced Data Management. If you have an older version of Lytec and you don’t want to upgrade, they can get you the new CMS form for your current version (back through Lytec 2006 I believe). Even if you don’t have Lytec, they might be able to help you. You can find them here at http://www.adm1inc.com or call them at (800) 888-2361. They have been busily helping their customers get ICD10 ready for the last three months (including me–thanks Jo-Ann!) and if you left it to the last minute, please don’t leave it any longer.

Happy Billing!

 

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Filed under Billing, Claims, Denials, ICD10