insurance denial

  1. M

    Insurance denial for 24071

    The insurance company denied after pre-pay refer stating code is inaccurate. Preoperative diagnosis: soft tissue NUB left upper arm A 15-blade scalpel was used to make a vertical incision directly over the soft tissue mass. This was carried down through the subcutaneous tissue using bipolar...
  2. F

    Question Partial Colectomy w/ anastomosis and small bowel resection

    please help ;) Can you code for both an open partial colectomy w/ anastomosis and small bowel resection? if so, do you add modifier 59 on resection? We are having trouble with reimbursement for both in the same setting. example 44140, 44120-59 Or is the resection bundled into the partial...
  3. M

    Question Insurance company paid facility but denied professional claim

    Has anyone ever had this happen? Insurance company ABC paid the facility for a procedure, but denied professional claim. Several calls have been made to ABC and representatives state the provider office needs to contact the facility for payment. (? What? Really, since when???) ABC says an appeal...
  4. C

    Seeking advocacy group for medical to combat unconscionable insurance practices

    Seeking advocacy group for medical practices to combat baseless denials Hi. I work for a billing group that services multiple medical practices. We are spending ridiculous amounts of time processing claim reconsiderations for denials that are baseless from any logical perspective. For...
  5. MeanderingMichigander

    Timely filing when patient DID NOT update insurance

    Howdy :) A patient was originally seen about a year ago and provided no insurance information. They made a couple small payments on the 2 bills over the course of a year. Then, they called almost a full year after originally seen and, "Oh! Here's my insurance - bill it, please!" Ugh. So...
  6. K

    31240 denying as inclusive to other endoscopy codes

    There is no CCI edit between 31240, 31255, 31267, 31276, and 31287, but I am getting denials on 31240 as inclusive. I have gotten these denials from both Anthem and Cigna. Has anyone else seen this, and is there a reimbursement policy I'm not aware of? Thanks for your help!