WIC billing questions

[Anonymous]

when billing for WIC, what diagnosis code is used for preg. women and infants under 1 year of age.

[Missouri Public Health Association]

For all WIC visits, I use diagnosis code Z02.9, with a CPT code 99211, and Z13.0 for hemoglobin stick.

[Missouri Public Health Association]

I use diagnosis code Z02.9/CPT code 99211 on all recerts with an EP modifier. For a new baby or a new pregnancy that has never been on WIC I use same diagnosis code but use 99201 and EP modifier. I also use Z13.0 with CPT code 85018 for hemo with a modifier TC for Homestate and emomed.

Cheryl Nelson

[Missouri Public Health Association]

For both cert and midcert:
I use diagnosis code Z02.89. I’m not sure what the difference is between Z02.89 and Z02.9, but I’ve never used Z02.9. For first time visit (new baby or anyone new to our health dept) I use CPT code 99201, and I use EP modifier for children/adults up to 20 years old and no modifier at all for anyone 21 and over. For anyone we’ve seen before I use 99211, again with EP modifier for children/adults up to 20 years old and no modifier for anyone 21 and over.

For hemoglobin:
I use diagnosis code Z13.0 and CPT code 85018, but no modifier at all. You do have to put in your CLIA number to get paid for hemoglobins, though. And for UHC you also have to give the referring physician’s name and NPI, and they have to have a QW modifier for hemoglobins.

[Anonymous]

Thank you for all the help. Jeri

[Missouri Public Health Association]

I use the same codes as Corrie. I havent had any issues with denials.

[Missouri Public Health Association]

For UHC do we put the referring doctor’s name and NPI in the box 24J?
We have no doctor on site, just standing order. I keep getting a rejection code of MA120 stating my CLIA address doesn’t match. I only have a drop window for servicing and billing address and they match. So of course it is going to review because service rep can’t answer.

[Missouri Public Health Association]

For WIC Billing we use Z01.89 for adult initial with 99201 CPT code. Other adult visits we use z01.89 with CPT code 99211. Pediatric initial Z02.89 CPT code 99201 EP modifier. Other pediatric we use z02.89 with CPT 99211 EP. Hemoglobin are Z13.0 CPT 85018. We haven’t had any issues with billing.

[Author]

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