Wiki 84165 Protein e-phoresis serum with MOD 26 is getting denied

[tpadmasree@gmail.com]

Hi, we are getting 84165_Protein e-phoresis serum denied when we code 84165 and 84165-26 as our hospital is charging 84165 for revenue code 300 and 84165-26 for revenue code 971 for professional(PRO) services. Can I get a possible solution from anyone in this group? Thank you.

 

[thomas7331]

From a purely coding standpoint, this appears correct, but you haven't said which payer is denying these or what the denial reason is so it's hard to advise without more information and detail. Some payers may not accept professional fees billed on a UB form, so that could be part of the problem - have you tried submitting the 84165-26 on a 1500 form instead?

 

[tpadmasree@gmail.com]

We are having denials from Aetna as primary payor