Wiki 69100 medicare denial

[O_KRECHKIVSKA]

Recently we got a lot of unpaid Medicare claims with CPT 69100. This code was billed to Medicare alone and some claims had office visits (with Mod-25) and Biopsy of external ear (69100). We received them with CARC CO-16 and RARC MA130, N822. I created Electronic Inquiry with NGS, received email from them that it is being worked and they will notify us by email when a response is available.
Does anybody else have this situation and what should I do? We didn't have this in past, it started as of last year (2024). It is a medical necessity to do this procedure and we don't code a general biopsy (11102, etc) instead of ear biopsy code (69100).

 

[reaganm222]

I'm having the same issue with Medicare and Medicare replacements. Have you received a response back about your inquiry?

 

[O_KRECHKIVSKA]

Hi, medicare still denies CPT 69100, but Aetna medicare advantage paid this code. I opened enquiry with NGS but I have no respond from Medicare till now. Usage of Mod-59 along with CPT11101 doesn't help, we tried to bill the code along and with Office visit - denied by medicare

 

[MBLAIRE]

Recently we got a lot of unpaid Medicare claims with CPT 69100. This code was billed to Medicare alone and some claims had office visits (with Mod-25) and Biopsy of external ear (69100). We received them with CARC CO-16 and RARC MA130, N822. I created Electronic Inquiry with NGS, received email from them that it is being worked and they will notify us by email when a response is available.
Does anybody else have this situation and what should I do? We didn't have this in past, it started as of last year (2024). It is a medical necessity to do this procedure and we don't code a general biopsy (11102, etc) instead of ear biopsy code (69100).

Working on a denial for 69100 from Medicare right now. Glad to see that it isn't isolated to just my clinic.

 

[O_KRECHKIVSKA]

I'm having the same issue with Medicare and Medicare replacements. Have you received a response back about your inquiry?

MEDICARE PAYS IF YOU ADD MOD-RT OR -LT

 

[Elizabethfourie64@gmail.com]

MEDICARE PAYS IF YOU ADD MOD-RT OR -LT

I just had a Medicare denial with an -RT : this is so frustrating. Does anyone have any further updates?

 

[catherinetinkey@entmedicalservices.org]

The denial code N822 indicates a claim was rejected due to missing or incomplete procedure modifiers. I would assume RT/LT. This code 69100 is included in an office visit code unless there is a substantially different diagnosis code. I would try the anatomical modifier and if that gets rejected I would call the carrier.

 

[sbutterwick]

Recently we got a lot of unpaid Medicare claims with CPT 69100. This code was billed to Medicare alone and some claims had office visits (with Mod-25) and Biopsy of external ear (69100). We received them with CARC CO-16 and RARC MA130, N822. I created Electronic Inquiry with NGS, received email from them that it is being worked and they will notify us by email when a response is available.
Does anybody else have this situation and what should I do? We didn't have this in past, it started as of last year (2024). It is a medical necessity to do this procedure and we don't code a general biopsy (11102, etc) instead of ear biopsy code (69100).

CPT 69100 Biopsy of External Ear REQUIRES A MODIFIER indicating which ear: RT or LT

 

[sbutterwick]

The denial code N822 indicates a claim was rejected due to missing or incomplete procedure modifiers. I would assume RT/LT. This code 69100 is included in an office visit code unless there is a substantially different diagnosis code. I would try the anatomical modifier and if that gets rejected I would call the carrier.

CPT 69100 Biopsy of External Ear REQUIRES A MODIFIER indicating which ear: RT or LT

 

[sbutterwick]

The denial code N822 indicates a claim was rejected due to missing or incomplete procedure modifiers. I would assume RT/LT. This code 69100 is included in an office visit code unless there is a substantially different diagnosis code. I would try the anatomical modifier and if that gets rejected I would call the carrier.

CPT 69100 Biopsy of External Ear REQUIRES A MODIFIER indicating which ear: RT or LT