AAPC - Back to school
Results 1 to 3 of 3

Thread: Medicare denial & proc code

  1. #1
    Join Date
    Apr 2007

    Default Medicare denial & proc code

    AAPC: Back to School
    Our office billed 44620-78,15330-59 and 36590-59 for a pts dos 2/24/10 to MC; MC pd 44620-78 but denied the other two "pre/post-op care payment is included in the allowance for the surgery/procedure". Checked the CCI and 15330 and 36590 can be billed separately. Does the coder need to change the modifiers or is this a write off?

    Our office also billed 13160-78 (dos 12/22/09), 44312-75 (dos 12/18/09) and 44146 (dos 12/10/09) for the same pt.

    Any suggestions or help is greatly appreciated!

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    I am having a problem with the timeline here
    so you started with the 44146 on 12/10 which I believe has a 90 day global
    then 44312 -75 0n 12/18 the 75 is a modifier that does not exist so not sure about that one
    then 13160 78 on 12/22 the 78 is because it is in global and I assume got paid
    then 44620 78 on 2/24 which got paid and is in global but the 78 pulled it out
    then 15330 59 on 2/24 not paid due to global
    then 36590 59 on 2/24 not paid due to global
    Is this all correct?
    If so then you need to correct
    15330 78 59
    36590 79 59
    you must use the 78 and 79 modifiers to pull these procedures out of the global as well

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007


    the mod 75 was a typo and should have been typed as 78.
    All the cpts were paid except for 15330 and 36590.
    Thanks so much for responding back so quickly re the correct mods!

Similar Threads

  1. Medicare--proc 29879 & OA
    By gmlittle in forum Orthopaedics
    Replies: 1
    Last Post: 08-05-2014, 05:54 AM
  2. Medicare denial code C0-107
    By lindacoder in forum Medicare Regulations
    Replies: 0
    Last Post: 05-07-2014, 02:46 PM
  3. Medicare denial code 16
    By Candylcook in forum Medicare Regulations
    Replies: 5
    Last Post: 10-10-2013, 05:42 PM
  4. Medicare denial code
    By mcrump in forum Billing/Reimbursement
    Replies: 6
    Last Post: 04-22-2013, 10:14 AM

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?


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.