Wiki Coding clairification

Messages
170
Location
Mechanicsville, VA
Best answers
0
I have a Chiropractor coding the following for a Medicare patient.
98941-AT
97112-GP
97140-59-GP
97012-GP
97110-GP

Claims are rejecting from payer with this info:
SVC Line Response- ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM SMARTEDIT INFO A POTENTIAL CODING ERROR WAS IDENTIFIED WITH THIS CLAIM PLEASE SEE STC 2220D LOOP FOR SPECIFIC INFORMATION. IF YOU WISH TO CONTINUE WITHOUT UPDATES PLEASE RESUBMIT THE CLAIM IN ITS CURRENT STATE TO BYPASS ADDITIONAL SMARTEDITING. | PROCEDURE CODE- 97112 MODIFIER(S)- GP^SVC Line Response- Returned to Entity. SMARTEDIT INFO A POTENTIAL CODING ERROR WAS IDENTIFIED WITH THIS CLAIM PLEASE SEE STC 2220D LOOP FOR SPECIFIC INFORMATION. IF YOU WISH TO CONTINUE WITHOUT UPDATES PLEASE RESUBMIT THE CLAIM IN ITS CURRENT STATE TO BYPASS ADDITIONAL SMARTEDITING. | PROCEDURE CODE- 97112 MODIFIER(S)- GP^SVC Line Response- Submitter SMARTEDIT INFO A POTENTIAL CODING ERROR WAS IDENTIFIED WITH THIS CLAIM PLEASE SEE STC 2220D LOOP FOR SPECIFIC INFORMATION. IF YOU WISH TO CONTINUE WITHOUT UPDATES PLEASE RESUBMIT THE CLAIM IN ITS CURRENT STATE TO BYPASS ADDITIONAL SMARTEDITING. | PROCEDURE CODE- 97112 MODIFIER(S)- GP

Is this being billed correctly?
 
Per CMS Guidelines:

Enter the appropriate CPT code that best describes the service:

98940: Chiropractic manipulative treatment (CMT); spinal, one or two regions
98941: spinal, three to four regions
98942: spinal, five regions
98943: CMT, extra spinal, one or more regions is not covered by Medicare.

AT modifier must be used on a claim for covered services (98940, 98941, and/or 98942) when
providing active/corrective treatment to treat acute or chronic subluxation

GA modifier to indicate that you expect Medicare will deny a service as not reasonable and
necessary and that you do have on file an Advance Beneficiary Notice (ABN) signed by the beneficiary

GZ modifier to indicate that you expect that Medicare will deny an item or service as not reasonable and necessary and that you have not had an ABN signed by the beneficiary), as appropriate on covered services

GY modifier must be used when suppliers want to indicate that the item or supply is statutorily noncovered or is not a Medicare benefit (all chiropractic codes other than 98940, 98941, and 98942)

GP is not a recognized modifier by CMS.
 
Top