Results 1 to 5 of 5

Denied E & M

  1. #1
    Exclamation Denied E & M
    Exam Training Packages
    Just recently our E & M codes are being denied when we are also perfomring a cortisone injection. For most of these cases, the patient has not been seen for 6 months to a year and are scheduled due to pain in joint. Our physicians normally do a comprehensive exam prior to offering the injection. Normal CPT codes:

    99213-25
    20610
    J1030

    The insurance companies that are denying these are private payors. Is anyone else also experiencing these denials? Any input would be appreciated.

    Thanks,

    Tisha Diederich, PCS,CPC
    Tisha Diederich, PCS, CPC
    215 Albert St
    Washington IL 61571

    tishadiederich@comcast.net

  2. Default
    I have had several payer's also do this lately. I called them and sent notes
    with a paper claim and they reprocessed them and paid.

  3. #3
    Smile
    Thanks for the response.
    Tisha Diederich, PCS, CPC
    215 Albert St
    Washington IL 61571

    tishadiederich@comcast.net

  4. Default
    I wouldn't go putting a 59 mod on 20610, that is incorrect coding. The way you have it is correct. I haven't had any problems getting them paid.

  5. #5
    Location
    Columbia, MO
    Posts
    12,568
    Default
    I agree with ILuvRock. Many times payers deny because they want to be certain you can appeal with correct documentation, you just have to play the game, but the standard is three, meaning a particular payer will usually deny the same thing three times and as long as you appeal successfully three times in a row then they will ordinarily leave it be from then on, if not I would send a letter to the supervisor.

Similar Threads

  1. 93320 & 93325 denied-Can someone
    By coders_rock! in forum Cardiology
    Replies: 4
    Last Post: 05-02-2012, 12:21 PM
  2. 27140 & 27066 denied
    By coders_rock! in forum Orthopaedics
    Replies: 3
    Last Post: 07-19-2011, 01:12 PM
  3. 29807 & 23700 denied
    By coders_rock! in forum Orthopaedics
    Replies: 5
    Last Post: 05-18-2011, 08:50 AM
  4. 62311 & 72775 denied
    By coders_rock! in forum Anesthesia
    Replies: 3
    Last Post: 05-17-2011, 02:20 PM
  5. E&M with Procedures being denied
    By iflyaway777 in forum E/M
    Replies: 1
    Last Post: 08-18-2010, 02:15 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.