Wiki Need notes...

[Partha]

We often get denials from payers asking for notes. Is there a way, say a cut off dollar value/category of CPTs, to determine codes which will require notes to be submitted during first submission to the payers? Unlisted codes and modifier 22 will require notes to be submitted.

 

[FTessaBartels]

Unlisted, Mod 22, Mod 62

In addition to the Unlisted codes and Mod -22 uses, I've found that virtually every case of co-surgey winds up being delayed with a request for medical records.

This may vary with payer, as well.

(Our billing office will NOT automatically send records for any reason; they always wait for the request ... ARGGH)

F Tessa Bartels, CPC, CEMC

 

[Herbie Lorona]

Yes when I use to bill for the hospital we had certain guidelines. I billed Medicaid and any Inpatient or Outpatient that was over a certain dollar amount they would always want notes so if you have a certain payer that is asking for notes you might try contacting them and asking them if there are certain codes, dollar amounts or anything else that they go by to know to ask for notes on.