45384 and 88305-denied?

k8e709

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cumming, GA
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Service Line: Code: HC<45384 Amount Charged: 610 Amount Paid: 0
Claim Adjustment: Group Code: CO Contractual Obligations
Reason Code: 204: This service/equipment/drug is not covered under the patient's current benefit plan


Service Line: Code: HC<88305 Amount Charged: 180 Amount Paid: 0
Claim Adjustment: Group Code: CO Contractual Obligations
Reason Code: 4: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

What modify should be used?
 

mitchellde

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Columbia, MO
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Service Line: Code: HC<45384 Amount Charged: 610 Amount Paid: 0
Claim Adjustment: Group Code: CO Contractual Obligations
Reason Code: 204: This service/equipment/drug is not covered under the patient's current benefit plan


Service Line: Code: HC<88305 Amount Charged: 180 Amount Paid: 0
Claim Adjustment: Group Code: CO Contractual Obligations
Reason Code: 4: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

What modify should be used?
Was this a screening, or diagnostic? What dx code(s) did you use for each one? Are billing for the surgeon, pathology, or facility?
 

k8e709

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cumming, GA
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45384-k62.5,k63.5,d12.6
88305-k63.5

Was told we can bill the path out from the facility when it's a PPO plan. Our doctor did the procedure at a ambulatory service center she does it at.
 
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