Wiki Trouble billing 99215 with other procedures

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lemiserena

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Hello, I am having a hard time getting info on why 99215 gets denied as incidental when billing it with 97112 and 90901. I am using modifier 25 on the E/M code. These are the denial codes:
CO97Payment is included in the allowance for another service/procedure.
N19Procedure code incidental to primary procedure.
Any insight greatly appreciated as I am not getting any answers from insurance companies.
 
Did you run it through an NCCI P2P checker? Did you read the NCCI manual for any further guidelines or clarification. Does the payer have a specific policy regarding office visits, biofeedback and neuromuscular re-ed together? Any other modifiers appended? What is the dx? How many units are being billed for the timed code? The other codes could be seen as therapy.

Could be a lot of reasons. The two reason codes are usually due to bundling but sometimes payers assign the wrong ones. Also, the CO97 might mean they don't care about a modifier they won't pay it separately.
 
Thank you so much! I did some further research, the codes are being bundled and I believe because the provider is using same diagnosis for all three procedures. This is happening with more than insurance company.
How do you use the NCCI P2P checker?
Really appreciate your response super helpful!
 
lemiserena said:
Thank you so much! I did some further research, the codes are being bundled and I believe because the provider is using same diagnosis for all three procedures. This is happening with more than insurance company.
How do you use the NCCI P2P checker?
Really appreciate your response super helpful!
Click to expand...
You're welcome. There are different ones available. Some of the MACs have one, Encoder programs usually do. If you want it directly from NCCI: https://www.cms.gov/Medicare/Coding/NCCI-Coding-Edits

PTP Coding Edits | CMS

In order to simplify the use of NCCI edit files, CMS will consolidate the two edit files into the Column One/Column Two Correct Coding edit file. Separate consolidations will occur for the two practitioner NCCI edit files and the two NCCI edit files used for OCE. This change will occur for...
www.cms.gov www.cms.gov

It could also have something to do with payer contracts. You may want to check with a manager or RCM supervisor depending on the volume and number of denials if this is something that is done with high frequency in your office.

If it's diagnosis related it's usually not those denial codes, but sometimes it can be.
 
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