Wiki Denial codes PI-B10 and PI-B15

[Kduckworth]

Who can help me figure out if the coding is incorrect or the modifiers? Please any help I can get!

99214 -25
17004
17111 -59
11102 -59
11103

I have PI-B10 denial on 11102 and PI-B15 denial on 11103.

 

[thomas7331]

I can't validate your coding without seeing the medical record, but your modifiers look correct to me per the NCCI edits and I don't see anything here that should have caused a denial. It could be the payer's error, or it could be that the payer uses edits that are different from NCCI.

 

[sinman0531]

Some payers do require -59 modifier on 11103, so you can try adding that. The 11102 should also have a -51 modifier attached. In the past we did not need to add -51, however in the past 6 months or so we have seen a sharp increase in denials in my practice where insurance wanted a -51.

 

[WIUCTX]

we billled
99214 25
90471
90476
The (UMR) insurance paid for procedure codes 90471 and 90476, but they denied the office visit billed under code 99214 with the denial code PI-B10. When I spoke to a representative from the insurance company, they explained that the denial was due to the payment already being included in another service. I am puzzled by this because we appended modifier 25 to the office visit code (99214), which indicates a significant, separately identifiable evaluation and management service. Additionally, the insurance company mentioned that they require the medical records for review. If anyone else has encountered a similar situation, I would appreciate hearing about your experience and any insights you might have regarding the insurance company's reasoning for this denial.