denied

  1. L

    Wiki Ventricular Tachycardia Denials

    Since the codes for ventricular tachycardia changed and gained a 5th character, they always seem to be denied. Both unspecified I47.20 and other I47.29. I can't seem to figure out why. It's on E/M charges, cath/PCI charges, EKGs. Practically anytime I use it, (and my docs love to use it) it gets...
  2. M

    Wiki Injection for Ocular pain

    I coded 67515-LT with Diagnosis code H57.12 and it was denied for not matching. What CPT code should I be using instead? This is just an injection for ocular pain.
  3. B

    Wiki Bundling Issue

    Hi all, I am getting a rejection from Veteran regarding procedure 29405, 29700, these being denied being bundled. I am just wondering if one can bill Application of leg cast and removal of leg cast at the same time. I would appreciate your help on this. thanks!!
  4. L

    Wiki ESSURE modifer - We are having claims

    We are having claims denied for lack of modifier on our ESSURE claims. We use 58565 and A4264, and one denial specified that the A4264 needs a modifier. We have tried mod 50 but that was denied. Thnx for any suggestions!
    • lizelder
    • Thread
    • a4264 claims denied essure modifier
    • Replies: 1
    • Forum: OB/GYN
  5. L

    Wiki ESSURE modifer - IN SC we have recently

    IN SC we have recently had our ESSURE claims being denied for lack of modifier on the A4264 portion. We have tried mod 50 but that did not work. Is 33 the appropriate modifier? Any thoughts would be appreciated!
    • lizelder
    • Thread
    • appreciated denied essure mod modifier
    • Replies: 0
    • Forum: Modifiers
  6. T

    Wiki Low birth weight code being denied

    I have a patient that was born prematurely and was coming in for weight checks to monitor growth. The physician is still using the P07.10 code even though the patient is gaining weight because they are still below normal. The patient is now 3 months old and we are getting denied for...
  7. S

    Wiki **** Humana is fixed**** innaproptiate denials of well visits

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
    • ssharp
    • Thread
    • 01/16/16 claims denied humana modifier
    • Replies: 0
    • Forum: Pediatrics
  8. S

    Wiki ****HUMANA is Fixed ***** denials of well visits with immunizations

    After working the insurance commissioner and Humana all claims processed from 12/12/15 to 01/16/16 should be reprocessed and paid correctly. They stated that there was an internal error where claims with a 25 modifier and 59 modifier were being denied incorrectly. I was able to locate a claim...
  9. N

    Wiki Egd and ercp coding

    Any reason why 43235 would get denied when billed with ercp stent and stone removal? Medicare has denied two stating a co-b15 issue. "required that a qualifying service/procedure be recd and covered. Should i use a modifier 59 on it?
  10. C

    Wiki Hip xrays denied for codes no longer valid

    All hip xrays that our office is submitting are being denied, stating no longer valid as of 1-1-2016 cpt 73500, 73510, 73520 are there new codes for 2016? Definitely not aware of any of this??? Can someone share their knowledge on this? Thank you cwilson orthopaedics
  11. F

    Wiki thoracic surgery

    My MD did an open flap drainage and a decortication at the same visit. I used cpt codes 32036 and 32225-59, however we are being denied for bundling. What can I do to get pass this? Any suggestions?
  12. R

    Wiki Biceps tendon exploration

    Surgery was scheduled for bicep tendon repair based upon MRI. However, when the surgeon got in there a tear was not found so all that was done was an exploration. I need help with the CPT for that. We originally filed this as unlisted and compared to 24341 but Cigna denied and tells us...
  13. R

    Wiki billing E/M level instead of injection

    I have a Dr. who has a question about billing just for his E/M level vist and not for the injection that he gave the patient due to it probabaly being denied. Is this kosher. I am under the impression that you cannot just do this? Any feed back would be appreciated.
  14. J

    Wiki Modifier QW - Does anyone know

    Does anyone know if the new Medicare UDS codes of G0477/G0478 require the CLIA Waived modifier QW? I don't want claims denied for not adding the modifier or vice versa. Thanks!
  15. K

    Wiki Denied for procedure incidental to another procedure

    I billed 32551 and 99255 on the same day and it denied. Should i have billed 99255/25 with 32551 to pay. I am new to hospital in pt billing. Thanks
  16. A

    Wiki Vaccine for children

    Can somebody help me with the State supplied vaccine for children Modifier. I`ve been using the Mod SS for more than a year, all of the sudden mostly of the NJHEALTH claims have been denied for wrong Modifier. Can also somebody give an example on how to post a well visit with vaccines
  17. J

    Wiki No fault won't pay driver was drinking

    OK I have a patient that was driving drunk when they were injured in a motor vehicle accident. Under NYS no fault, their insurance company is not required to pay. I billed them anyway and course they denied payment. This patient has straight Medicaid, will Medicaid pay for these office...
  18. D

    Wiki lcd

    I have a person who was seen and E&M code was 90791 with dx code 296.90. Not sure why this was denied. Could someone maybe have a better insight on this? Thanks!
  19. D

    Wiki E&M coding and psych

    I have 2 questions. The first one is a patient had an OV with nurse prac and then psych on the same day. NP coded 99213 and psych coded 90791 but the psych code was denied. Not sure how to code? The second question is patient was seen by psych dr and 90791 was coded but still denied. Not sure...
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