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#72736
03/28/2018 2:13 PM
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Joined: Jul 2015
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Can someone PLEASE help me understand when and how to properly use the EPSDT codes when billing for well visits for my Staywell patients?? I believe I was given incorrect information by the person prior to myself regarding the use of these codes and now Staywell wants a lot of money back from my provider due to inappropriate billing of those codes. Please...help...
Thanks!!
--Kris
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Joined: Jun 2010
Posts: 147
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what codes have you used.
did staywell mention what codes were used wrongly, or if some specific codes were missing
Richard
Pediatrician
Orlando, FL
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Joined: Nov 2011
Posts: 254
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Joined: Nov 2011
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There are a couple of possibilities. Are you paper billing or submitting claims on their web site. The codes are usually 2 letter codes and vary from insurance co to insurance co. If no treatments or referrals were done at the well child check, the code for " no refferals done" or "available, but mot used" should be used. If the patient has a sick code associated with the well child check and is being treated, the code for "under treatment" should be used. If a sick child is encountered for the well child check that needs a referral the code for "referral done or referred to other provider" needs to be used. I am sorry, I do not know the codes off hand.
If you are doing paper billing the codes are usually in the 24 H box. Sometimes the codes are printed in large font and the scanner of the ins. co reads them wrong.
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Raj
From (mostly) sunny Port St Lucie, florida
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