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Wiki B-Scan 76512 Rejected

K

kate.charette

Networker
Messages
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Location
Woodland Hills, CA
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Hello!
I submitted a B-Scan 76512-LT with Dx 362.29 to Medicare. It came back with the denial code -16 "Claim/service lacks information which is needed for adjucation."

I verified the following:
1) Name and address matched MCAR eligibility sheet.
2) MCAR number matches.
3) Bday matches.
4) Referring Provider entered.
5) Dx code is sufficient according to AAO Coding Coach and is listed as primary Dx.

I resubmitted the claim without the -LT modifier and it came back denied with the same error code.

Any suggestions on what to check next?

Thank you for your help!
~ Kate
 
Kate,
76512 is a Bilateral code. You should not bill with an LT or RT. Did you just resubmit? Did your claim have a message that allowed you to do that? If you haven't already tried, I would suggest reopening with no modifier at all. If you have already tried to reopen, though, you will have to do a first level appeal.
-Megan
 
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