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I have a recurrent issue of getting claims denied with the explanation that another doctor billed the same patient first for the same codes on the same day. I was told to use 25 as a modifier, but it still gets rejected. How can I make sure that my doctor gets paid for the services that were provided?
Thanks,
Shatha
Priority Billing LLC, Michigan
Can someone explain what this means ?
Thank you !
Regence BCBS of Oregon denied 80061, 82248, and 82977 as M15–Separately billed services/tests have been bundled as they are considered components of that same procedure.
Three of us have looked at all these codes, and at the Medicare guidelines, including the table of chemistry panels, and unbundled the codes to check for NCCI edits. We can’t find any reason for them to be denied.
I don’t know if this is limited to Regence, or if this is an across-the-board issue; the coding team was sent only the denial.
Is anyone having problems with these codes?
Does anyone else have had problems recently with HUMANA trying to take back money for CPT 50715 for incorrect Dx.?
We billed CPT 50715 with Dx. N13.5 – Uretral Obstruction. Is there another code I can use?
Thank you!
I am currently billing for a pediatrics office and the doctor bills out for codes 97802 (medical nutrition therapy), 83655 (lead testing), 36416 (collection of capillary blood specimen, using a finger stick) and 92587 (hearing test), along with the OV E/M code. But mostly none of the claims are being reimbursed, sometimes they get paid but most of the time they are not. Is there a modifier to be used such as a 59 or 24? Is anyone else billing this in their practice?
Thanks in advance.