I think I might be going crazy and need some help. 
We are auditing some charts and we originally billed as follows (I didn't code this but I know that the -5159 isn't correct right off the bat):
99213-25
52281
51702-5159
51798
We have Navicure as our clearing house and they sent back a denial stating that the 52281 is a component of the 51702.
I checked the CCI edits on the CMS webiste and it is showing the 52281 as a column 1 and 51702 as column 2 with no modifier available.
The coder told the CBO to delete the 52281 since it was included in the 51702 based on what Navicure edit stated which I don't think is right.
I also ran these codes through EncoderPro and I got the CCI Component listed as 52281 and 51702 but then below that it reads CCI Greater Px and lists 51702 and then 52281.
How can the 52281 be included in the 51702? Am I missing something? Where is the CCI Greater Px file located? I'm about to pull all my hair our!
I think it should be billed:
99213-25
52281
51798
Our Medicare carrier doesn't like modifier -51's added so I've left them off out of habit.
Thank you in advance.....
Lisa
Lisa S Hernandez, CPC, CPMA, CEMC
We are auditing some charts and we originally billed as follows (I didn't code this but I know that the -5159 isn't correct right off the bat):99213-25
52281
51702-5159
51798
We have Navicure as our clearing house and they sent back a denial stating that the 52281 is a component of the 51702.
I checked the CCI edits on the CMS webiste and it is showing the 52281 as a column 1 and 51702 as column 2 with no modifier available.
The coder told the CBO to delete the 52281 since it was included in the 51702 based on what Navicure edit stated which I don't think is right.
I also ran these codes through EncoderPro and I got the CCI Component listed as 52281 and 51702 but then below that it reads CCI Greater Px and lists 51702 and then 52281.
How can the 52281 be included in the 51702? Am I missing something? Where is the CCI Greater Px file located? I'm about to pull all my hair our!
I think it should be billed:
99213-25
52281
51798
Our Medicare carrier doesn't like modifier -51's added so I've left them off out of habit.
Thank you in advance.....
Lisa
Lisa S Hernandez, CPC, CPMA, CEMC