Wiki Claim denial

[lweathers41]

Good Morning,

I work outpatient hospital claims and we received a denial for ER claim 99283 mod 25 added to E/M. Codes 96361,96374,96375 all denied for invalid px for service date, code billed not supported per code def. Per call to Kaiser insurance rep stated these codes can't be billed separatley. When I looked up the codes 96361 and 96374 may be reported together. Can someone please lead me to correct billing of these codes. thank you

 

[sls314]

Good Morning,

I work outpatient hospital claims and we received a denial for ER claim 99283 mod 25 added to E/M. Codes 96361,96374,96375 all denied for invalid px for service date, code billed not supported per code def. Per call to Kaiser insurance rep stated these codes can't be billed separatley. When I looked up the codes 96361 and 96374 may be reported together. Can someone please lead me to correct billing of these codes. thank you

Why is there a modifier 25 on your ER line?

There is an NCCI edit between 99283 and 96374, but 99283 is the primary code. You shouldn't have a modifier on 99283.

Without seeing the documentation, I can't say whether it is appropriate to bill the 96374 as a separate, distinct line item.

After reviewing your documentation, if you determine that 96374 is appropriate and a distinct separately identifiable service that doesn't overlap the usual components of 99283, then you'd bill it with a 59 or XU modifier to indicate that it was a distinct service.

 

[lweathers41]

Why is there a modifier 25 on your ER line?

There is an NCCI edit between 99283 and 96374, but 99283 is the primary code. You shouldn't have a modifier on 99283.

Without seeing the documentation, I can't say whether it is appropriate to bill the 96374 as a separate, distinct line item.

After reviewing your documentation, if you determine that 96374 is appropriate and a distinct separately identifiable service that doesn't overlap the usual components of 99283, then you'd bill it with a 59 or XU modifier to indicate that it was a distinct service.

Thank you so much for your help. I currently don't work as coder but claim denials so I don't have the documentation to submit. But I will definitely send to our coding department for review. Thanks again.