I am a Coder and Biller at a pediatric Practice I have a question regarding CHRONIC CARE code 99358 for our Patients ( who are Complex care kids)
Here is my question:
Our complex care Patients if they come for WCC we bill once a year with Complex care code 99358 with their WCC as our Dr are reviewing their Charts before they come and managing their whole health.

So I put age based WCC with 25 Mod and 99358 code if the review time is 30-74 min on a complex care Patient.

My question is ANTHEM doesn’t pay 99358 code so as discussed with you and my manager we add 99213/99214 ( whatever level) with their WCC code
to get paid on Chronic/complex care kids.

Please advise is that right? as one of our Pt mom complain that when they are bringing their child for WCC why do they have to pay a copay as we billed WCC and E/M code ( instead of 99358) to Anthem. What should we do in these scenario.