Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Pathology & Clinical Laboratory
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 11-11-2011, 01:09 PM
jhaleycoder jhaleycoder is offline
Contributor
 
Join Date: Apr 2007
Posts: 13
jhaleycoder is on a distinguished road
Default Denial for 84443 80053 85025

Iam receiving a denial from Harvard Pilgrim in MASS; Proc code/modifier invalid on DOS For codes:

84443 DX: 414.9 401.9
80053
85025

When the rep called the insurance company said these codes were bundled. According to CCI edits they are not. Can anyone please help me out.

Thanks
Reply With Quote
  #2  
Old 11-11-2011, 01:28 PM
chenson384 chenson384 is offline
Contributor
 
Join Date: Apr 2007
Location: Paducah Kentucky
Posts: 16
chenson384 is on a distinguished road
Default general health panel

I am sure they are wanting you to bill this as a general health panel (80050) which includes these 3 labs.
Reply With Quote
  #3  
Old 11-11-2011, 03:27 PM
raidaste's Avatar
raidaste raidaste is offline
Guru
 
Join Date: Apr 2007
Posts: 106
raidaste is on a distinguished road
Default

I agree. When these 3 labs are done same day they shouldn't be unbundled. You need to bill them as 80050.
__________________
Stephanie, CPC, HCS-D
Reply With Quote
  #4  
Old 11-11-2011, 04:07 PM
btadlock1's Avatar
btadlock1 btadlock1 is offline
True Blue
 
Join Date: Apr 2007
Location: Lubbock, TX
Posts: 1,505
btadlock1 will become famous soon enough
Default

Quote:
Originally Posted by jhaleycoder View Post
Iam receiving a denial from Harvard Pilgrim in MASS; Proc code/modifier invalid on DOS For codes:

84443 DX: 414.9 401.9
80053
85025

When the rep called the insurance company said these codes were bundled. According to CCI edits they are not. Can anyone please help me out.

Thanks
Yes, you have un-bundled 80050. If you've billed this before without any problems (to Blue Cross, for example), what's probably happened is that they've actually paid you the allowable for 80050, over 1 or 2 of the charges, and denied the others as bundled. Some payers will rebundle them for you, and some won't. You should be aware, though, that it's considered an abusive practice to unbundle codes (or, to bill all of the components separately, when there's a comprehensive code that describes all of them together) - so try to avoid it.

All of the codes that start with 800XX are panels (bundle codes). I recommend making yourself familiar with them, so you can get an idea of when to use them, and what to bill with them. 80050 has a TON of codes bundled into it, because it's a combination of several panels and other labs. If you're going to bill all of the codes that make up a panel, bill the panel.
__________________
Brandi Tadlock, CPC, CPC-P, CPMA, CPCO
Reply With Quote
  #5  
Old 11-11-2011, 04:44 PM
btadlock1's Avatar
btadlock1 btadlock1 is offline
True Blue
 
Join Date: Apr 2007
Location: Lubbock, TX
Posts: 1,505
btadlock1 will become famous soon enough
Default I made this for my office...

This finally motivated me to put it in Excel

This chart shows all of the main codes that make up 80050 - (well, almost...) it's not all-inclusive - it doesn't take into account other codes that might be bundled-by-association (like 85027, for example) - but it lists out all of the codes in the panels that make up 80053. It's pretty self-explanatory, but if you can't figure it out, just ask me...

This is really handy when doing follow-up, for when you've got a huge list of labs billed, and codes from these bundles are billed and denied.
Attached Images
File Type: jpg 80050.JPG (45.2 KB, 217 views)
__________________
Brandi Tadlock, CPC, CPC-P, CPMA, CPCO
Reply With Quote
  #6  
Old 11-14-2011, 07:27 AM
jhaleycoder jhaleycoder is offline
Contributor
 
Join Date: Apr 2007
Posts: 13
jhaleycoder is on a distinguished road
Default

thanks so much!! thats going to be a big help to me!!! Do you know where I can get a list of test that need the QW modifier?
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 05:56 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC