Wiki 99144 - Medicaid is denying

[krisfelty]

A biller in my office has a problem with code 99144. AHCCCS(i.e Medicaid) is denying all claims for this code stating there is an age limit for this code. Minimum age 5-maximum age 20. Has anyone ever heard of this? They cannot give any explanation as to why stating, "They aren't certified coders." Well, I am and I have never heard of this sort of denial as it states this nowhere in any CPT book or other related material. If anyone has any input, I would really appreciate it!

 

[trep72]

99144

In the CPT book it states for code 99144, age 5 years or older, first 30 minutes intra-service time. Also this code has the exemptions to modifier 51 symbol.

Vontressa

 

[ka]

Coding Edge

A biller in my office has a problem with code 99144. AHCCCS(i.e Medicaid) is denying all claims for this code stating there is an age limit for this code. Minimum age 5-maximum age 20. Has anyone ever heard of this? They cannot give any explanation as to why stating, "They aren't certified coders." Well, I am and I have never heard of this sort of denial as it states this nowhere in any CPT book or other related material. If anyone has any input, I would really appreciate it!

I was just reading in the Coding Edge (September 2008) on pg 14 and they are talking about this code. Look there it might help.

 

[jdrueppel]

I have not personally experienced this denial but I have heard of it. As long as your patient is age 5 or older, your coding is correct. However, Medicaid may be denying it as not medically necessary in which case the payer is basically saying any patient over the age of 20 should be able to tolerate this procedure without moderate sedation. Since it's Medicaid, there's not alot you can do about it unless you have extenuating circumstances (i.e. patient is mentally handicapped). If it's not apparent I would ask the provider.

Julie Drueppel, CPC