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Medicare denials-Hello all I need

  1. #1
    Default Medicare denials-Hello all I need
    Medical Coding Books
    Hello all I need assistance patient had Mohs surgery on 06/24/11 17311, 17312 x2, and 14040 patient came in to clinic on 08/02/11 for office visit 99213 I applied modifier 24 but the carrier BC/BS is denying the claim as global to the Mohs surgery on 06/24/11 any suggestions?


    Thank you,
    TH

  2. #2
    Default
    Quote Originally Posted by tholcomb View Post
    Hello all I need assistance patient had Mohs surgery on 06/24/11 17311, 17312 x2, and 14040 patient came in to clinic on 08/02/11 for office visit 99213 I applied modifier 24 but the carrier BC/BS is denying the claim as global to the Mohs surgery on 06/24/11 any suggestions?


    Thank you,
    TH
    Call them and make sure it processed correctly (make sure they saw your modifier), and ask them to send it for review, if it didn't. As long as the E/M was completely unrelated to the Mohs (eg, NOT a follow-up visit), you should be able to report it. If they tell you that the claim processed correctly with the 24 modifier, then send an appeal with medical records showing that the visit was distinct. I'm willing to bet it was a claims processing error - they just got a new edit system a month or so ago, and they're still working out the bugs in it.

  3. Default
    Quote Originally Posted by tholcomb View Post
    Hello all I need assistance patient had Mohs surgery on 06/24/11 17311, 17312 x2, and 14040 patient came in to clinic on 08/02/11 for office visit 99213 I applied modifier 24 but the carrier BC/BS is denying the claim as global to the Mohs surgery on 06/24/11 any suggestions?


    Thank you,
    TH
    They are denying because it is global to the Mohs? Mohs is zero global. Maybe it is being denied because of the 90 day global on the 14040??

    Eitherway, if the 99213 is unrelated to the Mohs then it should be paid.

    Dee
    Dee
    CPC, CPCO, CPMA, CPCD

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