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Wiki 99213 and G0439 denials

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franco@carolinafpc.com

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I have tried to reach out to those who asked me questions regarding the 99213 and G0439 denials being denied although I am coding dx and modifiers correctly but cannot find their responses in the news feed. If you see this I wanted to respond by saying that the denial code is CO-97, meaning the payer has already covered a service or procedure in another payment or allowance, and therefore, the provider is not eligible for separate payment for the same service. Are the insurances allowed to outright deny the OV when there are legitimate codes other than the Z00 .00 or Z00.01? Any feedback would be appreciated. Does anyone know how I can feed my original question and answer the person who responded?

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There's a CCI Edit between CPT 99213 & G0439. You need to add modifier -25 to 99213 and make sure documentation supports of CPT 99213-25.
 
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