76513 Denials From GHI

[Salekca]

Hey, I am getting 76513 (H40.033 w/50)denials from GHI for: The diagnosis is inconsistent with the procedure. They didn't have problems with such coding before February 2024. Anybody knows what changed?
Thank you!

 

[CBLENNIE]

I'm guessing that the claims are being denied if you are billing modifier 50 appended to 76513 because the code is for performance of the procedure either unilaterally or bilaterally.


The MUEs for this code is 1 unit per DOS, so you aren't going to get paid for 2 scans if it is performed bilaterally.

 

[Salekca]

I tried billing it without 50 as well. The denial reason: The diagnosis is inconsistent with the procedure.
Any other ideas?

 

[natashalage]

I don't know either. In Encoder, the list does not have H40.033. not sure if that's the problem. the best way to call the payer.