1. D

    Question 28470 not preformed

    Provider billed 28470x2 diagnosis: M84.374A After appealing with chart notes, UHC says that the chart notes do not support that the 28470 was preformed. Dispensal of pneumatic cam walker was documented and diagnostics were preformed to accurately diagnose the fracture. All of this information...
  2. M

    Question 29824 - Arthroscopic distal claviculectomy

    I am needing some help with an appeal. The insurance is Humana Medicare Choice PPO. I billed 29824 and 29826. First, they requested medical records before processing the claim. I submitted the records. They denied the claim stating the services were not documented in the medical record. I...
  3. T

    Question Unbundling

    Can I get some insight on unbundling services? I have a couple of scenarios. 1. 64633-50, 99070, S0020, J3301 ( RF Ablation with use of lidocaine, Marcaine, and Kenalog. 99070 was billed for misc supplies) 2.99203-25 62321, 62323, 99070, J3301, Q9966 (New patient visit where a cervical ESI and a...
  4. A

    Question Denial dexa claims

    I have a 72 male patient with United healthcare Medicare plan coming iN did screening dexa. The insurance first denied the screening code, then denied it shin when we tried to bill as diagnostics dexa. Really don’t know what’s wrong with it....
  5. K

    Critical Care Denial

    I'm working on a denial for a patient that saw two of our intensivists in the ICU on the same day. Dr. A saw patient 1st for just under 74 minutes so we billed 99291; Dr. B saw patient second so we charged 99292. This is how we have always billed critical care and we've had no issues with...
  6. E

    Modifier 55 NIGHTMARE

    Can anyone please tell me how to get a claim paid when using modifier 55? We had a patient who came in as post operative management care after having ORIF on tibia out of state. According to Medicare guidelines you are to bill the procedure using date of procedure with modifier 55 and place of...
  7. R

    Assistant Surgeon Billing

    I work for an orthopedic surgeon who does predominantly worker's compensation billing. Recently, we have gotten denials from some of the insurance carriers denying the assistant surgery due to "the surgeon must specify what specifically the assistant performed." We have never heard of this...
  8. E

    Denial from Primary

    If a patient has two insurances and the primary denies (denial is appealed and upheld), do you have to bill the secondary insurance? A co-worker was told to adjust and to not bill the secondary at all.
  9. S

    Wiki Need help why Medicaid-AL been denying CPT 36902

    Hello, we billed 36902 by itself and MCD-Alabama has been denying it for " M49: Missing/incomplete/invalid value code(s) or amount(s). N59: Please refer to your provider manual for additional program and provider information." ANyone help me please...Thank you.
  10. K

    Anthem BCBS Denying 2nd Eye Cataract Surgery

    Is anyone having issues with Anthem denying/rejecting the second eye cataract surgery within global of the first eye as "modifier used is inconsistent with procedure?" 66984 - RT w/ ICD-10: H25.811 66984 - 79, LT w/ ICD-10: H25.812 We have never had issues before and cannot get through to a...
  11. M

    58544 and 58700 denial?

    Has anyone had any issues billing these codes together? Are they being denied as inclusive to each other?
  12. X

    93015 Medicare Denial

    Hi everyone! Our practice is new to cardiology coding. We are continuing to get Medicare denials for CPT code 93015. The denial code is N-182 "This claim/service must be billed according to the schedule for this plan." I appreciate any and all support, advice, or assistance! Thanks...
  13. G

    Denials from medicaid

    Hello, I have run into an issue with Medicaid stating that 1) L21.0 has an age limit. This I don't understand because this is a code for Dandruff and anyone can get dandruff at any age? However there are no other appropriate codes to assign to this patient from the medical record. 2)...
  14. C

    Federal BCBS rejecting 62323 and 62321

    We have been having issues all of 2017 with FEP denying 62323 and 62321. First for medical records, and then when we send them, that our providers are not eligble to perform the service. 62311 and 62310 we never had any issues with nor are we having any issues with any of our other injection...
  15. E

    Z80.0 clinical edit error BCBS Michigan

    Anyone experiencing denials for Z80.0 with BCBS? I've run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I've talked with provider services, reported the issue and believe since Oct 1st they have an error in their...
  16. L

    Uhc & emg 95886 add on denial for max qty

    I have done everything I could to research this further. No matter how I bill this whether it is 1, 2, 3 or 4 units on line line item it denies. It does not do this for ANY OTHER carrier. This billing for up to 4 units per line item was acceptable until 2015- mid 2016, then late 2016-early 2017...
  17. G

    Working Medicare without Medicare FISS DDE system

    Does anybody here have any advice for working Medicare denials when you don't have access to the FISS DDE system? My practice is having a terrible time getting denials fixed. Every time we resubmit something, it will get denied as "M80" which is essentially a duplicate. Medicare describes it...
  18. M

    HELP!!!! Hopice/Home health billing!

    I work for a Home Health agency and have billed claims for a patient beginning on 5/3 the patient was discharged from Hospice on 5/2 the patient's insurance (Humana) has denied the claims stating "due to the fact that the patient was under hospice care." I have appealed the decision showing that...
  19. J

    Denial Billing secondary with G code.

    I need help, keep getting secondary denials because of the g code used when billing medicare as primary. Secondary denies because of the g code but we must use that when billing medicare, tried billing secondary without the g code but then it denies because it doesn't match the primary amounts...
  20. T

    BCBS FL denials for B20 (HIV)

    Is anyone else having an issue with BCBS of FL denials for diagnosis B20 (HIV)? They think that this is an inactive code as of 2017 - but I have checked CMS' site and CDC listing of ICD-10 and both show it as valid for this year with no planned addenda for the April 1st release either.
  21. daedolos

    Noridian Medicare denial

    I've been assigned research on a claim denial for reason code "CO-50" = non-covered services not deemed necessity by payer. Patient came in for neck pain and doctor examined and applied trigger point injection in the posterior aspect of the neck then prescribed physical therapy. However, the...
  22. Y

    CARC and RARC books

    I need to find a good set of books that outline the CARC and RARC codes and rules. Also, any other books for working through rejected and denied claims would be helpful as well. Any suggestions? Thanks
  23. H

    76942 (ultrasound guidance) denied with nerve block

    Hi All, Ultrasound guidance (76942) is being denied by Oxford when billed with a nerve block code (64413, 64445, etc.). We have tried to appeal saying you need the guidance to ensure precision of the needle however, they are still denying it. :mad: Anyone run into this problem and found a...
  24. B

    Medicare denying Ultrasound Guidance used with Regional Block Placement

    Since January, CMS has been denying about 85% of our claims for ultrasound guidance 76942-26. Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc). Some of our appeals have resulted in the claim being reprocessed, but...
  25. L

    Denial of multiple units of lesion excision (same CPT)

    We've recently started to see denials for excisions (same CPT) on the same claim. For example, 11403 x 3 units. Sometimes 1 unit will pay and other times none will pay with a message that the modifier used is incorrect or missing. We were able to get these paid until now with -76-59 on the...
  26. K

    Global maternity

    The patient was seen an excess of 7+ visits and then the c-section with post partum visits. Has anyone ever had an insurance company deny billing the global with the post partum because her plan will be termed prior to her global post partum completion date?? 6 weeks post partum and her...
  27. L

    NCV denials from Medicare

    We are seeing an increased number of denials from Medicare for NCV testing (95911-95913) when billed alone (without the EMG). The denials state 'not deemed a medical necessity'. Dx codes used are included in the LCD. Anyone else having this problem?
  28. A

    do you need a modifer when using 97032

    I have just received a denial on a claim that I submitted to Tufts. I am working for a chiropractor and I have used 97032 before with no modifier used and now I get the denial CO-182 meaning Payment adjusted because the procedure modifier was invalid on the date of service. This has never...
  29. M

    Wiki ICD-10 DX for smoking cessation

    I am having some trouble with Medicare paying 99406 or 99407 when billed with E/M code using Dx F17.210. The denial is for "not medically necessary" Any suggestions? I appreciate any help Maru
  30. J

    Home Health

    Can anyone help me with this? If a patient is being treated with Home Healthcare and the referring physician authorizes and or signs the Plan of Care but it is not filed to insurance and is not timely filing, can we A) still bill for denial or B) can we file for the re-certification even thought...
  31. E


    Has anyone been paid for Telemedicine? Looking for any input, codes used and what are the denial codes if you get any.
  32. L

    66761-LT denial

    I've received a denial from an insurer for 66761-LT stating it was within the global period of another procedure. Exactly 7 days prior we billed for 66761-RT. Am I correct in thinking the 66761-LT wouldn't be included with 66761-RT since it is a separate procedure done on a different site of...
  33. E

    Blue Cross Denial for POS 32 w/ 99310

    Hello, I have a few claims sitting on my desk denying because they are stating that 99310 is incompatible with POS 32. Our physicians visit patients in the Nursing Home. Now - BC has paid 99304-99309's, as this this pts had been in the POS for some time. (Nursing Home bills using POS 32...
  34. E

    99310 in POS 32... Blue Cross

    Hello, I have a few claims sitting on my desk denying because they are stating that 99310 is incompatible with POS 32. Our physicians visit patients in the Nursing Home. Now - BC has paid 99304-99309's, as this this pts had been in the POS for some time. (Nursing Home bills using POS 32...
  35. B

    N.C. Mediciad Denial for preventive visits on children

    We just recently went to ECW and we cannot get reimbursed for preventive care visits on children. We are using the EP modifier with the CPt codes. our denial reason states attending provider not eligible on service dates. and B7=This provider was not certified/eligible to be paid for this...
  36. M

    Medicare denial for 88305 and 88342

    I got denial for 88305 and 88342 from Medicare. According to remittance advice modifier(S) was missing. Do I need to apply modifier 59 to 88305? I am confused I did not know that any modifier needed for those codes.
  37. D

    73564 denial

    hi I am new to orthopedic and I keep getting a denial for 73564 RT with diagnosis S80.01XA indicating diagnosis inconsistent with procedure, any advice would help, thank you Laura
  38. S

    HUMANA denial for J02.9 not allowed as primary

    We just received a denial from Humana insurance stating that J02.9 is an invalid primary dx code. I do not see any specific guidelines for that code saying it cant be primary. Can someone please let me know if they are having trouble with this also. Thank you
  39. D

    TSH denials from medicare

    Hello! I work for a neurologist who regularly orders thyroid stim hormone assays (CPT 84443) in conjunction with other tests to check for Peripheral neuropathy after a trans ischemic attack or a stroke. The tests that come back abnormal are being paid, but we have 3 that came back normal that...