Wiki Billing/Reimbursement for Prolonged Services

[britneyjay06@gmail.com]

I'm getting denials for billing 99354 (which I am billing as an add on code in addition to the office visit code). The denial I am receiving states the diagnosis is inconsistent with the procedure. When I speak to the insurance rep, they advise that we are not using the correct diagnosis codes with 99354 and that we either have to change the diagnosis code or remove the add on code, 99354. Most of our patients either have breast cancer or an associated lump/benign mass. We billed 99213 and 99354 for one patient. The diagnosis codes we billed with 99354 for this patient was c50.412 and I74.4 representing malignant neoplasm, but the insurance still denied. We billed 99215 and 99354 for another patient and billed N60.81, N60.82, Z15.01 and Z80.3 as the diagnosis codes for 99354, and this denied as well. Can someone please help me?

diagnosis codes, diagnosis coding

 

[mitchellde]

I'm getting denials for billing 99354 (which I am billing as an add on code in addition to the office visit code). The denial I am receiving states the diagnosis is inconsistent with the procedure. When I speak to the insurance rep, they advise that we are not using the correct diagnosis codes with 99354 and that we either have to change the diagnosis code or remove the add on code, 99354. Most of our patients either have breast cancer or an associated lump/benign mass. We billed 99213 and 99354 for one patient. The diagnosis codes we billed with 99354 for this patient was c50.412 and I74.4 representing malignant neoplasm, but the insurance still denied. We billed 99215 and 99354 for another patient and billed N60.81, N60.82, Z15.01 and Z80.3 as the diagnosis codes for 99354, and this denied as well. Can someone please help me?

I don’t see that you are doing anything wrong can you perhaps post the note without identifiers? I have used thes codes in the same way with no problems at all. I attach all dx codes to both line items.

diagnosis codes, diagnosis coding

 

[britneyjay06@gmail.com]

I don’t see that you are doing anything wrong can you perhaps post the note without identifiers? I have used thes codes in the same way with no problems at all. I attach all dx codes to both line items.

I attached all dx codes to both line items as well. I'm thinking I should have them send it back for a second review...

diagnosis codes, diagnosis coding