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Medicare billing - Please help

  1. #11
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    Medical Coding Books
    Level of service code, 99213, 99214 etc..

  2. #12
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    Tacoma, WA
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    1,087
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    Quote Originally Posted by tsmiddle@nfpmedcenter.org View Post
    Level of service code, 99213, 99214 etc..
    Ok. So the CPT and ICD-9 codes are fine. The next avenue to explore is whether or not any of the patients with these denials have had a surgical procedure in the previous 90 days. CMS must be considering the visits "non-covered" for some reason, and that is the next logical assumption. If the patient had a surgery by ANY provider in the previous 90 days all office visits will be considered non-covered, unless you can show the condition is not related to the surgery. Usually that means a modifier is needed. So we need more information surrounding the circumstances of the patient.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #13
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    Call the Medicare contractor! If you see the CO96, look for the other remark codes on the EOB-they usually explain the denial in more detail. (M__ , N___, MA____ ....)

  4. #14
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    Tacoma, WA
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    1,087
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    Quote Originally Posted by hopepg View Post
    Call the Medicare contractor! If you see the CO96, look for the other remark codes on the EOB-they usually explain the denial in more detail. (M__ , N___, MA____ ....)
    And those codes are usually found under the patient name area of the EOB...sometimes hard to find but they should be there.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #15
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    We would really need the CPTs used to help you with this per ICD code denied. Thanks!

  6. #16
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    Sorry did not see page 2 when I wrote the above message!

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