New E&M coding

Anyone letting patients know ahead of time in writing that the new E&M coding is going to lead to more split bills? If so, can you share what you are giving to your patients?

Kate Senecal
Richmond, VA

Can you explain what you mean by a split bill?

I just got a giant pile of denials from BCBS where they are claiming 99072 is an invalid code for 2021. It is rejecting the entire claim, but not front end by clearinghouse. After they receive it. In 2020 BCBS accepted 99072 but it was a zero pay bundled code.

How the heck are pediatricians supposed to get reimbursed for all the pandemic extras when we are blocked from CARES act (unless take medicaid) and denied by private insurers? Dr. Lori

We have not yet seen this from BCBS but from one of our local payers starting 1/1/21. I submitted a request to the AAP coding hotline and this was their response:

I would suggest that you reach out to the plan because it sounds to me like the code was removed from the system (in error) and it cannot be. It is a HIPAA covered code and while they do not have to pay, under HIPAA they have to accept it.

We are working with our local group of pediatricians and our state chapter to contact the payer.