Jernst
Guest
I have an odd scenario, patient with Prim Dx of Vascular Dementia received services for Neuropsych Testing, coded: 1-Unit of 96138 (for initial 30 min) + 8-units of 96139 for additional 4 hours of testing, then 1-unit of 96132 for Psychologist's initial hour of review of testing, interpretation and report writing + 2-units of 96133 for the additional 2 hours of report writing. Medicare has denied 96132, 96133 and the 96138 all with rejection code "not medically necessary"! They approved and paid on the units for 96139! - Wha?! This makes absolutely no sense to me at all! Can't even have a 96139 without the 96138, plus the 96132/33 and 96138/39 are married, in that the testing of 96138/39 would be nothing without the interpretation and report writing 96132/33...
I called and spoke with someone at Medicare and they said, "probably need a modifier". I explained that we have NEVER used a modifier in this scenario, nor would it make sense to do so. She then said, "then file an appeal".
My question is:
Has anyone else come across this?
Could it just be a mistake, or is there some new rule or modifier in this situation that I'm unaware of?
Wondering if efforts would be better geared toward resubmitting with a modifier (perhaps -59?...even though that doesn't really make sense), or in pursuing the appeal?
(fyi: we had another patient on the same remit advice with exactly the opposite denial: they approved 96132/96133/96138, but denied all of 96139 - saying: "previously paid" (IT WAS NOT) and "not medically necessary".. SOMEONE EXPLAIN THAT - ugh!)
I called and spoke with someone at Medicare and they said, "probably need a modifier". I explained that we have NEVER used a modifier in this scenario, nor would it make sense to do so. She then said, "then file an appeal".
My question is:
Has anyone else come across this?
Could it just be a mistake, or is there some new rule or modifier in this situation that I'm unaware of?
Wondering if efforts would be better geared toward resubmitting with a modifier (perhaps -59?...even though that doesn't really make sense), or in pursuing the appeal?
(fyi: we had another patient on the same remit advice with exactly the opposite denial: they approved 96132/96133/96138, but denied all of 96139 - saying: "previously paid" (IT WAS NOT) and "not medically necessary".. SOMEONE EXPLAIN THAT - ugh!)
