Wiki 99490 Quest Denials

[claire@alohavein.com]

Hello! Our clinic recently began offering Chronic Care Management (CCM) services starting in February this year. Overall, things are going well, but we're encountering a recurring issue with quest denials for code 99490. The reason provided is:
"234: This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"
"M15: Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed."

Could you assist us in resolving this matter? Thank you so much in advance!

 

[rthomas@impcna.com]

Hello! Our clinic recently began offering Chronic Care Management (CCM) services starting in February this year. Overall, things are going well, but we're encountering a recurring issue with quest denials for code 99490. The reason provided is:
"234: This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"
"M15: Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed."

Could you assist us in resolving this matter? Thank you so much in advance!

We have been doing CCM for several years and here are some reasons for that denial. If the patient has an E/M visit anywhere on the same date as your CCM billing date. If you bill for Home Health certification & re-certification you can NOT bill CCM in the same month. If the patient was an inpatient in the hospital on the CCM billing date it will be rejected for this reason.