UHC and knee xrays

jensanders16@yahoo.com

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Is anyone else having issues with United Healthcare (Community Plan and United Healthcare Shared Services) denying E&M codes inclusive to knee xrays (specifically 73560)? We are an orthopaedic group that frequently performs knee xrays on patients. I have contacted both insurance carriers mentioned and have been told that the E&M is denied due to global. When questioned about the "global" code, I have been told 73560 is a global code. I have asked if this is perhaps a computer error as I have not found any reference on the website or in their newsletters that this is something new, as well as Novitas doesn't list 73560 as a "global" service. All the reps can do is just send the claim back to the claims department requesting a more detailed denial and they will call me back in 15 business days.
If you have found a way around their crazy processing system, other than modifying -25 on the E&Ms (which is unnecessary), can you please let me know? This is a large issue as I said since we have quite a few patients that this is affecting.
 

CodingKing

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I think they are mixing up globals. The code 73560 is global as in it includes the technical and professional components. However that's completely separate from E&M service. Any chance its being done in the global period for a surgery the patients have had and that's what its actually denying for. It seem odd they would bundle an x-ray and an E&M.
 

Jkwiatek

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UHC X ray denials

We are having the same issue with x-rays when billed with an office visit. (we are also an orthopedic office) I have called UHC to have reprocessed and they have been denied again. This is really getting frustrating. Have you had any resolution yet?
 

jensanders16@yahoo.com

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Uhc knee xray denials

No response yet. I have called UnitedHealth Shared Services as well as United Healthcare Community Plan (as this seems to be UHC across the board) to have them review it. No one can ever give me more info than "included in global". When I question what global, they just say that they will have to send it back to claims and will call me back. No one has ever called back yet. I am now looking at another one so I thought I would check the forum again.
No, the patient's are not in any kind of global service, no I&D, no injection, no fracture, no surgery. Some of the denials are new patients to our office too. VERY VERY frustrating!
Thanks
 

1formissy

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UHC is a common payer in which services are erroneously denied, seems like on a daily basis.

My resolution is to ensure you report the Chief Complaint on the E/M, for example, KNEE PAIN, and the diagnosis on the X-ray, for example, chondromalacia patella. And of course, make sure you are appending the -25 modifier.
We all know the modifier -25 is not diagnosis driven, however, it does represent the E/M is supported by the patient's presenting problem(s). Or in these cases, Chief Complaint(s).
 
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