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Thread: pre op labs denied by Medicare

  1. #1
    Join Date
    Apr 2007
    Melbourne, Florida

    Default pre op labs denied by Medicare

    AAPC: Back to School
    Medicare denied labs/ we billed for a pre op exam / medicare paid for the visit and xray but
    denied the ua + 36415 as as non covered /rtn exam included in payment

    would it make a difference if we put a modifier 59 on the ua
    modifiers 59 / 51 on the 36415?
    99214 v72.83, 715.15, v72.82, v72.63 .........................(paid)
    71020 v72.82 pre procedural repiratory exam ....(paid)
    81002 v72.63 (pre op labs) ................................... (denied)
    36415 v72.63 ( pre op labs)................................... (denied)
    I will look at the ncci edits..just wanted to throw this out there for any suggestions .. Thanks
    Denise Gilrane-Pillow, CPB

  2. #2


    You may need to add another dx in addition to v72.63. Our policy at the clinic I work for is.. for Medicare preop labs we bill the co-morbidity (if applicable), V72.63, and then the reason for surgery. For medicare preop ekgs we bill the co-morbidity (if applicable), v72.81, and then the reason for surgery.

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