Progyny help
I went for a fertility consult ( met with the doctor for 40 mins). There was no physical exam or testing done. My clinic submitted it as a ‘ bundled service’ to progyny originally. This was incorrect as that includes diagnostic testing. Clinic then asked them to downgrade it to a consult only. It showed up as ‘ consult with ultrasound ‘ which is not correct— there was no ultrasound. I told her to reach back out again and she copied and pasted their reply to me ( weird.. as if I speak medical coding??). Does 99205 include an ultrasound ?
The blood work they are referring to was 1 blood test that took place at Labcorp. 99499 is what they use as the bundle code so it seems they downgraded this with a ‘ modifier -52’ because of the bloodwork. Why can’t that be its own code versus a downgraded bundled code?
Does any of this make sense? Also not sure why it’s 99205 as I am a new patient to the clinic. Their new patient code on their own website is different. What am I missing here? I actually feel sick to my stomach going back and forth with them about this. It’s been going on for months trying to get a simple consult appointment and 1 effing blood test billed correctly.