CPT Code 64405

binal0508

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Hello everyone,
I am new in Billing. I am doing Rejections, in that the CPT code 64405 has bilateral and thats what the procedure was done and still it is DENIED.
99214 M1 25 , M2 X2
64405 M1 50 Adjustments - CO-236 =
This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.​
20552 M1 XS
J1020

I am not sure why this has denied.

Please can someone help me in this .
 

danachock

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Brainerd, MN
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Hi binal0508,
64405 (is a column 2 procedure) when you bill it with 20552 (which is a column 1 procedure) therefore procedure 64405 would need an appropriate modifier to be billed with 20552 for your claim. Good luck resolving your denial; I recognized adjustment code CO236 that is a claim adjustment code. This appears to actually be a claim denial versus a claim rejection. Be sure to stay timely and make the correction within your payer's allotted time.
The reason I state this is because where I am employed a claim rejection is when something is amiss and the medical claim cannot get out the door (to be "actually" submitted & received by a payer") because either "door A" our company edit(s) simply state that something is amiss or "door B" where the payer we are trying to send our claim to will not accept it because something is wrong.
Thanks for listening and have a great evening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Associate Analyst
 

binal0508

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Hello,
I have received a medical billing denial for

#DatePOSCPTModUnitsBilledAllowedPaidReason & Remark
105/20/20191164493X21.0$330.00$0.00CO 151More Info
205/20/20191164494X21.0$160.00$0.00CO 151More Info
305/20/20191164495X21.0$160.00$0.00CO 151More Info
405/20/201911990701.0$75.00$0.00CO 97 N19

Can some one help me with this ... 586442
 
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