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99213 and 73630 in same visit

MSFoot45

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Im getting a denial for below filed:
99213(25)(1,2,3,4)
73630 (1,2,3,4)
(1) M77.52
(2)M79.606
(3)R26.9
(4)R60.0

Any tips for why my 73630 got denied for "inconsistent modifier or required modifier is missing"?
This is through Humana insurance, they paid for the OV

Thanks!
 

mitchellde

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13,308
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Columbia, MO
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The radiology of the foot needs a lateraling modifier for right or left or both. Also you have again linked diagnosis to the 73630 code that do not supply medical necessity for a foot X-ray. Pain in an unspecified leg for example first there is no such thing as an unspecified leg so I would never use that code, if the provider cannot specify which leg they had pain in then in my opinion it was not important to the provider and I would not code it. Second you would not perform a foot X-ray for leg pain. Also the unspecified gait code and the edema code I would not link to the X-ray. How you link your diagnosis codes is just as important as which codes you select.
 

MSFoot45

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The radiology of the foot needs a lateraling modifier for right or left or both. Also you have again linked diagnosis to the 73630 code that do not supply medical necessity for a foot X-ray. Pain in an unspecified leg for example first there is no such thing as an unspecified leg so I would never use that code, if the provider cannot specify which leg they had pain in then in my opinion it was not important to the provider and I would not code it. Second you would not perform a foot X-ray for leg pain. Also the unspecified gait code and the edema code I would not link to the X-ray. How you link your diagnosis codes is just as important as which codes you select.
Thanks so much for you help on this one.
We leave the coding to the doctors at first go, when we get a denial we step in and follow through and then update the doctors on best coding. Almost suggestively...you know what I mean. Im printing out all of my responses to refer back to. This way I can try to solve a problem with out duplicating a question.

Again, thanks!
 

Orthocoderpgu

True Blue
Local Chapter Officer
Messages
853
Location
Salt Lake North
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Your doctors should not be coding

Just because you can perform an office visit or procedure does not mean that you can code them. This is a perfect example. If your doctors think they can code an office visit, give them an E/M audit sheet and see if they can accurately fill it out.

You need to have a certified coder review what the providers suggest before being submitted to insurance. If you keep submitting claims this way, you will be stick out like a sore thumb on the insurance side and get on their radar. All procedures need to be submitted and linked only to the diagnosis that the procedure was performed for. That includes office visits, X-rays, injections or anything else that can be done. A CPC needs to verify the procedures are properly documented and all codes are supported by documentation before anything gets submitted to insurance.
 
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