Wiki Humana denying 77427 as bundled

Create Wiki Sort by date
T

Tazcheetarah

Contributor
Messages
12
Location
Greensboro, NC
Best answers
0
I have been fighting with Humana for a couple months now as they are denying several of our 77427 as bundled although there are no CCI edits on the claim. We did not have this problem previously, it just started a couple months ago and we are billing with a date span. When I call provider services I get the run around and am basically being told that they don't know why it denied. The claims I have had sent back for manual reprocessing are being paid but I still have new denials coming it. If I try to appeal they deny my appeal. Has anyone else had this issue? It is happening in multiple practices for us.
 
0
Tazcheetarah said:
I have been fighting with Humana for a couple months now as they are denying several of our 77427 as bundled although there are no CCI edits on the claim. We did not have this problem previously, it just started a couple months ago and we are billing with a date span. When I call provider services I get the run around and am basically being told that they don't know why it denied. The claims I have had sent back for manual reprocessing are being paid but I still have new denials coming it. If I try to appeal they deny my appeal. Has anyone else had this issue? It is happening in multiple practices for us.
Click to expand...

I just had that come up last week - we don't do a lot of Humana, so it was the first time I saw it.

I'm pulling together some information to dispute it. The denial is ridiculous - they told my follow up person that if any other rad onc procedure had been billed within a certain time frame, then 77427 was not payable.

Which means they obviously don't understand what 77427 represents. Sure, the facility is billing the actual treatment code for that day, and sure the physician billed a treatment plan prior to treatment beginning. But the 77427 is how the physician gets paid during the ongoing treatment phase.

If I get anywhere with them, I will let you know.

BTW - there's a Facebook group for Rad Onc Coders & Billers. I haven't posted about my Humana claim yet, because I wasn't sure if it was just a one off. Since you're also having problems, I'm guessing it is more of a widespread issue. You're welcome to join the group and commiserate with the rest of us. :) https://www.facebook.com/groups/radiationoncologycoders
 
0
sls314 said:
I just had that come up last week - we don't do a lot of Humana, so it was the first time I saw it.

I'm pulling together some information to dispute it. The denial is ridiculous - they told my follow up person that if any other rad onc procedure had been billed within a certain time frame, then 77427 was not payable.

Which means they obviously don't understand what 77427 represents. Sure, the facility is billing the actual treatment code for that day, and sure the physician billed a treatment plan prior to treatment beginning. But the 77427 is how the physician gets paid during the ongoing treatment phase.

If I get anywhere with them, I will let you know.

BTW - there's a Facebook group for Rad Onc Coders & Billers. I haven't posted about my Humana claim yet, because I wasn't sure if it was just a one off. Since you're also having problems, I'm guessing it is more of a widespread issue. You're welcome to join the group and commiserate with the rest of us. :) https://www.facebook.com/groups/radiationoncologycoders
Click to expand...
I am in that group already. 😂😃

But yes I had one rep tell me the denial was based off of medicare guidelines and I flipped out! This was after the same rep tried to tell me it was bundled to 77014 then when I said that's not correct they said oh it's 77263. The reps I have spoke with have no idea what they are talking about.

I'm assuming some code edit for their auto adjucation has been put into place incorrectly As this has never been a problem until recently. I just don't know how to get the attention of someone who can actually fix this issue.
 
0
We have also been having some problems with Humana and the 77427 code. We have two issues. First when there are 3 fractions leftover at the end of treatment, we should be able to bill the 3 fractions as a week with the 77427 code. Humana is denying this indicating there are not 5 days between the from and to dates so it is not valid. We are also getting denials for the 77427 when billing for Quad Shots. With a Quad Shot the patient has four treatments over 2 days, two treatments on each day. Again we get a denial indicating the date span is not allowed.

Humana must have some type of check in place that requires 5 days in between the from and to date for the 77427 code. Although this is generally the case there are situations when the from and to dates will be less than 5 days apart.

I don't think Humana understands this.
 
0
I found some additional information on this on Humana's website.


If you follow the above link, it has a Claims Payment Policy for the 77427 code. I had never seen this before or even new it existed. Also this policy was revised 06/2022 and that is when I think we started having issues with the 77427 code.

I think Humana requires additional information in the Comment and just not the number of fractions.
 
0
comicsfan said:
I found some additional information on this on Humana's website.


If you follow the above link, it has a Claims Payment Policy for the 77427 code. I had never seen this before or even new it existed. Also this policy was revised 06/2022 and that is when I think we started having issues with the 77427 code.

I think Humana requires additional information in the Comment and just not the number of fractions.
Click to expand...

Thanks for finding that! I wonder what the change was in June 2022 - I might look around and see if we have the old policy saved somewhere.

We don't have a lot of Humana here, but it will be good to have this as a reference for how to bill when we do!
 
0
I can't seem to find the article to which you are referring. Is there a direct link to the article ? When I click the link it takes me where I can search the policies but the only thing I see issued on 6/1/22 is for automobile accidents.
 
0
Tazcheetarah said:
I can't seem to find the article to which you are referring. Is there a direct link to the article ? When I click the link it takes me where I can search the policies but the only thing I see issued on 6/1/22 is for automobile accidents.
Click to expand...

The policy is at that link, and it is titled Radiation Treatment Management. If you scroll down about halfway, you can see it. Or if you enter the keyword radiation in the search bar at the link, it will filter directly to the policy for you as well.
 
0
Just wondering guys I notice that it says about the comments for MA plans that they require it "IF" original Medicare would do so and our original Medicare does not require addt comments when submitting 77427. From what I read we are submitting them exactly to the T of their guidelines and they are still denying. It is only our MA plans that we are seeing this denial for.
 
You must log in or register to reply here.
Top