Question 99497-33 DENIAL

gijones66

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WE ARE BILLING
99214-25 DX: I10, E11.9, Z79.899, N183 (E&M)
G0439 DX: Z00.00
99497-33 DX: Z71.89
96372 DX: E53.8
J3420 DX: E53.8

CPT CODE 99497-33 IS BEING DENIED FOR CO-236 PROCEDURE OR PROCEDURE/MODIFIER COMBINATION IS NOT COMPATIBLE WITH ANOTHER PROCEDURE OR PROCEDURE/MODIFIER COMBINATION PROVIDED ON THE SAME DAY ACCORDING TO NCC.
I TRIED MODIFIER 59 ON CPT CODE 99497 AND IT DENIES AS (4)- PROCEDURE CODE IS IINCONSISTENT WITH MODIFIER.

I WOULD APPRECIATE ANY HELP I CAN GET. THANK YOU, GLENDA
 

jhendrix08

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I know the denial code says it's the procedure/modifier but I feel like it might be an issue with the Dx code used with 99497. Medicare doesn't pay for any type of counseling so I would try to attach the Dx Z00.00 to it instead and still keep the 33 modifier; that is the correct one. Also, when we bill scenarios like this I also add modifier 59 on the 96372.
I hope that helps.
 

jhendrix08

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This is directly from the CMS website; it's a fact sheet for Advance Care Planning which includes how to bill for it.

Medicare waives the coinsurance and the Medicare Part B deductible for Advance Care Planning when:
● Provided on the same day as a covered AWV
● Furnished by the same provider as a covered AWV
● Billed with modifier –33 (Preventive Services)

Voluntary ACP is considered a preventive service when billed with the AWV on the same day by the same provider, so CMS waives the deductible and coinsurance for ACP. When AWV is medically necessary and billed with ACP, but the AWV is denied for exceeding the once-per-year limit, payment can still be made for the ACP. In that case, CMS applies the deductible and coinsurance to the ACP service. The deductible and coinsurance DOES apply when ACP is provided outside the covered AWV.
 
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