CodingWiz2021
Contributor
Hi... Is anyone receiving claim rejections from UHC specifically related to 15777? Should I bill this differently? With a 50 mod although CPT says not to?
I recently received 3 automatic denials from UHC for claims where we billed for the acellular dermal graft. Using CPT 2021, I billed 19340 (with 50 mod for bilateral) and 15777 RT and 15777 LT.
The denial listed
I submitted a form on UHC's website asking them to explain why this claim was denied. The reply leads me to believe that their scrubber is automatically denying claims for any add on code or at least this one. I heard back via email today and the reply was this:
Thank you for your inquiry regarding the SMART Edit for add-on procedures. I have forwarded your request to the SMART Edit developers for review.
EDI Support acts as an intake source for the SMART Edit team from external customers.
Also, this edit does fall in the “Return” type which means it is held in our frontend for five days allowing time for updates to be made based on the SMART Edit returned. After that five days, the claim is released to the claims platform for consideration. This specific claim is being released from the clearinghouse and frontend today. The review of the edit can still take place with the information you have provided.
Thanks in advance for suggestions/advice.
I recently received 3 automatic denials from UHC for claims where we billed for the acellular dermal graft. Using CPT 2021, I billed 19340 (with 50 mod for bilateral) and 15777 RT and 15777 LT.
The denial listed
P4999ADODN SmartEdit (ADODN) Procedure 15777 is an add-on code and must be reported with the primary code. It is recommended the Add-on and primary code be reported on the same claim form. Update code(s) as applicable for services rendered.' |
I submitted a form on UHC's website asking them to explain why this claim was denied. The reply leads me to believe that their scrubber is automatically denying claims for any add on code or at least this one. I heard back via email today and the reply was this:
Thank you for your inquiry regarding the SMART Edit for add-on procedures. I have forwarded your request to the SMART Edit developers for review.
EDI Support acts as an intake source for the SMART Edit team from external customers.
Also, this edit does fall in the “Return” type which means it is held in our frontend for five days allowing time for updates to be made based on the SMART Edit returned. After that five days, the claim is released to the claims platform for consideration. This specific claim is being released from the clearinghouse and frontend today. The review of the edit can still take place with the information you have provided.
Thanks in advance for suggestions/advice.