Recently Medicare is denying my ua's (81002) stating reason 16 Claim/service lacks information or has submission/billing errors; and N575 Mismatch between the submitted ordering/referring provider name and the ordering/referring provider in our records. N264: Missing/incomplete/invalid ordering provider name. They are paying for the E/M service the same day and I'm using a 59 modifier showing that this was a separate lab procedure. Anyone know why this is happening? Just started this past few weeks.
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Wiki Medicare is Denying My Ua's (81002)
- Thread starter shirleyj1608@gmail.com
- Start date
please see this article. you need -25 on E/M
http://www.medicarepaymentandreimbursement.com/2016/08/cpt-codes-81001-81002-81003-and-81025.html . it also explains the N264 denial requirements
http://www.medicarepaymentandreimbursement.com/2016/08/cpt-codes-81001-81002-81003-and-81025.html . it also explains the N264 denial requirements
vgriffin
Contributor
Since this is a lab, no 25 modifier is needed. I would check to make sure you have a referring doctor and that the correct information is populating in box 17
SharonCollachi
Guest
If there is no referring doctor other than your own doctor, put that info in box 17. A lab done in the office will deny without a referring/ordering doctor, which is what it sounds like they are telling you.