need help with denial PLEASE

solocoder

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Can anyone give me a clue as to what this claim adjustment reason means? The payer is out of network for our providers, if that helps any:

#107 The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

:confused:
 

CodingKing

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https://med.noridianmedicare.com/we...lifying-claim-service-not-identified-on-claim

Looks to primarily be add-on code missing the code its used with

Common Reasons for Message
• Primary CPT has not been billed
• Primary CPT was not billed on same claim

Next Step
• View claim history to determine if primary CPT was billed ◦ If not, add-on code cannot be billed
◦ If so, review medical documentation to determine if secondary code can be billed

• Submit claim for primary CPT
• Submit Appeal request. See Appeals webpage for instructions on how to submit a Reopening or Redetermination

Claim Submission Tips
• Verify primary CPT was billed prior to billing add-on code


PS. I just put the full wording of the denial in google and the above link was the first one on the list

sincerely,

CodingKing aka GoogleKing
 
Last edited:

solocoder

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Thank you so much for your reply. In this case, there was no add-on code used. Just a toe amputation and adjacent tissue transfer. 14040 and 28825 51,TA.
??
 

CodingKing

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Maybe missing modifier 59 on the secondary procedure? Of course I would not expect that to be the denial reason for that. Of course no NCCI edit that I can see.
 
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