Wiki CPT 99144 & Medicare

[jenndeshon]

I work in oral & maxillofacial surgery and we are having a major issue with claims that include CPT code 99144 when we send them to Medicare. Our contractor here in KY is CGS Administrators. The claims go through our clearinghouse but are rejected by Medicare for "invalid unit or basis for measurement code" and "information submitted inconsistent with billing guidelines". I have contacted Medicare to try to figure this out but, of course, they were not helpful. Besides that, our claims are not in their system so they cannot look at them. Contacted our software vendor but they do not see a problem. Have an open case with Emdeon (our clearinghouse) but not really expecting them to have the answer, either. I have attempted to bill units on these but those are rejected as well. Since the code description includes an amount of time plus an add-on code for additional time, I do not see why this would be required. These procedures are all performed in an office setting.

I am extremely frustrated, confused, and stressed over this. I am desperate!!! Please, please, please help out a fellow coder!

Thanks in advance,
Jennifer, CPC

 

[aaron.lucas]

well first of all, I know this sounds like it might be obvious, and "duh", but did you make sure the procedures do not include moderate sedation? Beyond that, for the units, since the codes are time based, does the documentation include the time the patient was under sedation? other than those two things, I cant think of any reason why it would be denied.

 

[marvelh]

Just on a "wild guess" based on the denial code - Are you billing the minutes in the units of service like anesthesia claims are submitted OR are you reporting 1 unit of service for 99144 and 1 + units for 99145?

Moderate sedation services would be reported with a maximum of 1 unit of service for the parent code, 99143 or 99144 and multiple units of service for 99145, but not the number of minutes of moderate sedation.

OR is the 99144 being reported with an anesthesia modifier, such as AA?

I found that this denial reason was one of the top denial reasons this spring for the 5010 format for many of the contractors? If so,
this was the edit #
X222.351.2400.SV103.020 and

this was the business edit message:
This Claim is rejected for Invalid Information submitted inconsistent with billing guidelines for the Unit or Basis for Measurement Code. and

this was the explanation...
2400.SV103 must be "MJ" when SV101-3, SV101-4, SV101-5, or SV101-6 is an anesthesia modifier (AA, AD, QK, QS, QX, QY or QZ). Otherwise, must be "UN".

If it's not one of the above two issues - reporting time as units or reporting an anesthesia modifier, I would check with your clearinghouse as it might be associated with the 5010 electronic format

Just a guess but may be worth checking into!

 

[jenndeshon]

Thanks for the responses!
We are billing these as 1 unit since the time is built into the code. We do have the documentation for sedation times as we have a sedation sheet fo every surgery that documents many aspects of the sedation such as type & amount of medications used as well as IV start and stop times.
I did check Appendix G as directed in coding book and the procedures we are performing are not included there.
I had also wondered about the AA modifier but we had not previously been required to use it. Attempts to use such a modifier in the past have resulted in denials for invalid modifier (although, I admit, I haven't tried that in a few years). I have a case open with our clearinghouse because I, too, question if this is a 5010 issue.
Let me know if you come up with any other suggestions.

Thanks!
Jennifer, CPC