Medicare and 99292 - denials

BarCode

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Hello - any help I can get on this will be greatly appreciated! I'm at my wits end.

I'm billing Medicare for critical care; 99291 plus 99292 (sometimes there are multiple 99292).
These are claims that are billed electronically, they are completely correct and appropriatly coded.
The documentation and time are consistent with the codes billed BUT they are all being denied by Medicare.
They all ask for a modifier. I've appealed them all and lost the first appeals.
I've tried using units for multiple 99292s and I've billed them all as separate line items.

Tried modifiers (59 and 25) nothing. Any other ideas or?

TIA
 

Herbie Lorona

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Denial code

Hello - any help I can get on this will be greatly appreciated! I'm at my wits end.

I'm billing Medicare for critical care; 99291 plus 99292 (sometimes there are multiple 99292).
These are claims that are billed electronically, they are completely correct and appropriatly coded.
The documentation and time are consistent with the codes billed BUT they are all being denied by Medicare.
They all ask for a modifier. I've appealed them all and lost the first appeals.
I've tried using units for multiple 99292s and I've billed them all as separate line items.

Tried modifiers (59 and 25) nothing. Any other ideas or?

TIA
What is the denial codes they are putting on the claim?
 

BarCode

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Hello and thank you for replying.
These are the two denial codes that are used.
One visit was billed with a 36556 (CVC) and one wasn't. Both were billed with 99291 and time / documentation was clear and sufficient.

This is happening to nearly all 99292s. I've read the HPI referred below, with no resolution.

I've tried billing as units or as individual line items. They've all be appealed and denied.

CO97
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: refer to the 835 Healthcare Policy Identification Segment loop 2110 Service Payment Information REF, if present.

CO172
Payment is adjusted when performed/billed by a provider of this specialty. Note: refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

Thank you
 

mallory615

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I bill 99291, 25 modifier, then 99292 (with the appropriate number of units). Our claims never deny. Are you billing any other E&M codes on the same day? I would also check into your taxonomy codes. Are your providers Critical Care certified?
 

BarCode

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I bill 99291, 25 modifier, then 99292 (with the appropriate number of units). Our claims never deny. Are you billing any other E&M codes on the same day? I would also check into your taxonomy codes. Are your providers Critical Care certified?

I've done the same - not billing with any other E&M codes on the same day
Taxonomy codes are correct
What do you mean "Critical Care Certified? They're Intensivist & Hospitalist:confused:
 
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