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Medicare Rejection CO 18

  1. Default Medicare Rejection CO 18
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    Hello, question is i am billing 95903 and 95904 to Medicare, I am billing it for upper and lower extremities. I am getting paid on one set of 95903 and 95904, but for lower i am getting rejection of CO 18 what means its a duplicate. There is a modifier i can use for both sets of 95903 and 95904 to be paid. What is that modifier? Is it -76? Please help. Keep in mind both 95903 and 95904 can be quanity billed. Let me know.

  2. #2
    Location
    Columbia, MO
    Posts
    12,571
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    They are not quantity billed they are each nerve. So you have a 95903, then 95903 59, and so on for each nerve then your 95904, 95904 59 and so on for each nerve. You do not use the 76 as it is not repeated when it is a different nerve, and you cannot use 50 or LT, RT because nerves do not have laterality.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Ok, i am not sure i understand. Here is real situation. I am billing 95903 - 4 units then 95904 - 6 units for upper NCV and 95861 - 1 unit for needle test. Then on the same day for the same patient i am billing 95903 - 4 units then 95904 - 4 units and 95861 - 1 unit. And i am getting rejection of duplicate for the second set of billings, so my question is what modifiers do i need to put for the second set or bill it under upper and lower dx codes and just put more units?

  4. #4
    Location
    Columbia, MO
    Posts
    12,571
    Default
    You do not bill with units you bill for each nerve if you test the same nerve multiple times then you can only bill for one. I have doen this many times and it never works well using units, it is not a quantity code it is EACH nerve, so you bill a
    95903
    95903 59
    95903 59
    95903 59
    95903 59
    95903 59
    95903 59
    95903 59
    then do the same with the 95904
    This is the way I have done these for years now ever since being denied payment and underpaid when using units.

    Debra A. Mitchell, MSPH, CPC-H

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