Part B Insider - 2014 Issue 2
Reader Question: Ensure Face-to-Face Counseling for 99407 with 99213
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Article Overview
This reader Q&A explains common reasons claims for smoking-cessation counseling may be denied when billed with an office/outpatient evaluation and management service. It focuses on general billing setup, payer coverage considerations, diagnosis reporting, and service location/type-of-service conventions, making it useful for coders, billers, and practices handling preventive counseling claims.
Why This Topic Matters
Denials for counseling services billed with other same-day services can stem from payer-specific edits, coverage limits, diagnosis requirements, or claim fields. Understanding the broad claim setup issues covered here can help practices troubleshoot denials and confirm whether a payer’s response reflects coding, coverage, or administrative rules.
Article Sections
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Question
The reader’s billing scenario and the denial issue are introduced, along with the claim setup questions being raised.
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Answer
The response discusses general considerations for reporting smoking-cessation counseling with another evaluation and management service, including service format, claim edits, coverage limits, diagnosis requirements, and payer follow-up.
What You Will Learn
- How the article frames same-day billing issues involving smoking-cessation counseling and an office visit
- What general claim elements may affect payer acceptance of counseling services
- Which kinds of payer and coverage checks are discussed in the article
- Why diagnosis reporting and service classification can matter for these claims
Who Should Read This
- Medical coders
- Medical billers
- Practice staff
- Compliance staff
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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