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 are 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

 

[dseyfried]

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 are 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

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1324CP.pdf

Check the list of codes that are not to have moderate sedation billed on page 3.

 

[jenndeshon]

Thanks, Debra!

I did check Appendix G and none of our procedures are listed there but I appreciate your link because there are so many things that can be easily overlooked.

If you think of any other suggestions, please let me know!

Thanks!
Jennifer, CPC