Wiki Billing 93000 with 94620

[kmcdowell@pfcadocs.com]

We billed 93000 and 94620 on the same day. The test were performed in a PCP office. UHC Medicare Advantage is denying the 93000 stating: "CO234 - 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.)". 786.05 and 786.50 were the dx we used on 93000; 786.05 was used on 96420. Can someone please help me on this?

 

[kstevens24]

UHC Medicare denied CPT code 93000 because there is NCCI edit conflict when billed with CPT code 94620. The NCCI edit conflict is the misuse of column two code with a column one code; an appropriate modifier may be appended to override this edit. CPT code 93000 (column 2 code) is considered to be a component of the more comprehensive CPT code 94620 (column 1 code). Therefore, without an appropriate modifier being appended these two codes when billed together will always be denied. I'm unsure of the circumstance of the patient's visit, however, you may append the following modifiers:

Modifier 59
Modifier XE
Modifier XS
Modifier XP
Modifier XU

I hope this information helps!