Wiki multiple 99292 denial to Mcare

[BarCode]

Hello-
I could really use some guidance here. Medicare has denied billings with multiple 99292 codes (billed w/ 99291) stating that they are duplicates.

Patient meets all criteria for critical codes, was seen X 155 minutes, by one physician.

Medicare states that I need to add a modifier that signifies this is not duplicated services.

What do they want?

TIA - BC

 

[BarCode]

Does anyone bill multiple 99292's ? Do you bill them to Medicare? Please tell me if you add a modifier to them so they aren't denied as "duplicates".

Thank you

 

[FTessaBartels]

How - EXACTLY - did you bill it?

Might help if we knew EXACTLY how you submitted the claim?

Could be all they want is the documentation to prove the length of time spent in critical care.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[13kpcpc]

Are you billing in multiple units?

I work for a group of critical care physicians, this is the way we would bill these services:

Example: 155 minutes
99291-25
99292 x 3 units of service

Hope this helps!
Kim Pizzo, CPC,CPMA

 

[BarCode]

Are you billing in multiple units?

I work for a group of critical care physicians, this is the way we would bill these services:

Example: 155 minutes
99291-25
99292 x 3 units of service

Hope this helps!
Kim Pizzo, CPC,CPMA

Thank you Kim - no, I'm currently not using units and I will try that. In the past, units were not accepted but things change.

I appreciate your help.

 

[BarCode]

Might help if we knew EXACTLY how you submitted the claim?

Could be all they want is the documentation to prove the length of time spent in critical care.

Hope that helps.

F Tessa Bartels, CPC, CEMC

Not sure what you mean by exactly but here goes;
I send the claims electonically
On a single claim there's 99291 and 2 99292s each on a separate line.
They have not been denied for documentation.

Medicare states, "you've excluded the correct modifier" (actual quote)
No other services/procedures were included

Thank you for your response

 

[mhstrauss]

Not sure what you mean by exactly but here goes;
I send the claims electonically
On a single claim there's 99291 and 2 99292s each on a separate line.
They have not been denied for documentation.

Medicare states, "you've excluded the correct modifier" (actual quote)
No other services/procedures were included

Thank you for your response

If your MAC doesn't allow units for this code, and you are putting it on separate lines, they are probably looking for a modifier 59; your claim would be:

99291
99292
99292-59


Or like someone above said, put 99292 with 2 units if that would be allowed. I believe ours does; might be worth a shot.

Hope this helps!