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Wiki Medicare denial CO4

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mackeyjean

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Naches, WA
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Hello,

Noridian Admin Serv is my Medicare carrier.

Since 02/19/13, all procedures billed to Noridian for our Physician Assistant's have been denied with CO4. (The procedure code is inconsistent with the modifier used or a required modifier is missing.) An example would be 99213-25 with 17004 and dx code 702.0. The office charge is processed. 17004 is immediately denied for a missing modifier. As you are aware, there is no missing modifier.

Upon receiving the first denial I contact Noridian for explanation. They swear a fix is in place, however I am now up to 192 procedures denied.

Is anyone else having the same problem? Am I missing something that changed?
 
Re: Medicare CO4 issue

Hello!
We had the same issue, there was an error on Medicare's part in February 2013 having to do with PA claims and requiring modifiers on all procedures--nothing has changed coding-wise it was just a Medicare processing mistake. I have been told this was caught on 03.14.13 and auto-adjustments to all affected claims will begin 04.14.13, however, we have yet to see those adjustments come through.

Hope this helps,

Mallory, CPC, CPCD
 
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