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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    I reviewed the split claim suggestion given here on the forum with our Medicaid rep and she said that they would except the split claim since our clinic is staffed with midlevel and oral MD providers. I now have to get the other providers that I would bill under but who are really Medical...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    Thank you! I am going to speak to our providers and make sure they are comfortable with me splitting the claim, I think may be the solution for us.
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    Thank you for responding, we are really struggling with this. We did think about just billing them as POS 11 but I reached out to Colorado Medicaid and they said that if the provider is off site then we would have to bill the E/M as POS 2. So we billed that way and they denied the E/M and paid...
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    Thank you so much! I was thinking we were the only ones out here doing this. We currently have a policy that we only see PrEP for HIV, walk in STI testing, and sick visits on the virtual days, no injections. We would love to do vaccines at the same time as a lot of our patient population is...
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    Wiki Too many DX Codes for Medicare?

    ICD Diagnosis Code Requirements Introduction -Here is a link to CMS FAQ on ICD. Electronic claim submission you can have up to 19 ICD codes per claim.
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    Wiki Can we give injections/vaccines to patient when the provider is virtual

    We are a HIV/STI clinic in Colorado and we have providers who are virtual to our clinic once a week. The patients still come to the clinic but the provider is virtual on screen in the exam room. If the provider orders vaccines we have been getting denials on the E/M and paid for the vaccine. The...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Your coding is spot on. If BCBS of Florida is like Athem in Colorado they will deny the 36415 we bundled even with the 25. It is such a sore spot here. Also, does Florida have a PrEP assistance program? We have PHIP here in Colorado that is based on federal poverty level that will pay for cost...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    There is no alternative then to bill the Z29.81 because they are being seen only for PrEP for HIV. There are guidelines set up for this special billing. For more information I have attached a good presentation on billing for HIV for PrEP and injectable PrEP. I know that in general the coding...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    There have been big changes since the adoption of ICD 10 Z29.81. I have had claims from Cigna and Anthem BCBS deny now to modifier 33 misuse. Our claims have been paying now with no cost share when using Z29.81 without modifier 33, for all payers but Cigna open access. Open access is falling...
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    Wiki Telehealth visit & EKG & injections done later that day

    We are having the same issue. We are a small STI clinic and our provider does two days as mixed virtual. He is on video but the patient comes in for their lab work, vaccines, injectable HIV medications. When it is just an injection visit with no face time to provider we have no problem, we bill...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Even more news! I met with Gilead today and they said that we can now amend any E/M code with a modifier 33 to indicate that the services are A or B rated and should be processed with no copay or deductible. I also checked the forum under Modifier 33 and the information there supports the use of...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Hi everyone, I was able to get an awesome guide to PrEP billing from the HIV Medicine Association. I realize now it is all in the Diagnosis code that the payors use to determine it is a PrEP visit. I will be following my claims closely to see if this solves the Aetna and Anthem Problem. I have...
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    Wiki HIV Pre-exposure followup

    We are a Ryan White funded HIV care clinic and we serve many PrEP patients. We bill 99202-99204, 99212-99214 with modifier 25, and 99401-99404. We use the combination of Z11.3 or Z11.4 with Z20.6 and or Z77.21 as well as Z79.899 if applicable. This always gets paid. We do have a problem with our...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Hi everyone, thank you for all this information. I am going to contact all our contracted payers and ask that they provide guidance on how they would like us to bill for the PrEP visits. our health Access department has also sent the Anthem letter regarding grandfathered policies to the state...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Thank you for looking into this. I felt like I had it right because all other payers are covering the visits as prevention, then in July we started getting all the Anthem claims back with copays and patients were so surprised. Any help is appreciated.
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Thank you for all of this. Anthem did send me a copy of this and stated that the best way to ensure coverage is to appeal the claim when a copay etc. is applied. I am seeing from all the advise that this may be a diagnosis code issue and not a CPT issue. Thanks again.
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Does the insurances apply a copay and or coinsurance/Deductible when you bill E/M with Modifier 25 + 99401? the main issue we are having is that patients understand that PrEP should be covered at 100%. Out of pockets have been charged on our claims as well as the LabCorp bill. When I appeal the...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    When we opened the clinic four years ago we met with the Colorado department of public health and environment and this was the advice they gave us. ACA also states PrEP is covered under prevention. We are also funded by Ryan White so we are bound by many rules CDPHE lays out. I am beginning to...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    Thanks everyone. We are in network with BCBS Anthem. I have not had a claim that I appealed that doesn’t get rerun as prevention. I’ve had a few United healthcare (we are in network) self insured groups that are not ACA but when I appeal them they also cover as prevention. I am having to appeal...
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    Wiki preventive medicine codes vs preventive counseling codes for HIV PrEP

    We are a Community Based Organization with a small LGBTQIA+ clinic. In addition to our care for those living with HIV, we see many patients who are on or would like to be on PrEP (pre exposure prophylactic's). We have been coding the established PrEP visits with CPT 99396 or 99395 and diagnosis...
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