Hi
an you please help with the process of this type of denial. Is there a cms link that a dx invalid to a procedure or a website that can help me validate if the denial is correct
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Tag Archives: inconsistent
93000 “Procedure code is inconsistent with the patient’s age?”
The office I work at is Internal Medicine and this is my problem.
Insurance is Humana and the patient is a 26 year old female.
The following was billed.
99395, 80050, 93000, 83036-QW all with diagnosis code Z00.00.
All were paid except the EKG 93000. It states "The procedure code is inconsistent with the patient’s age."
Any advice would be greatly appreciated. Thank you.
-79 modifier inconsistent with CPT code 20526 ????
Scenario: Patient in post-op for RIGHT carpal tunnel release is seen and given an injection into the LEFT carpal tunnel. I billed 20526, 79, LT and Medicare
denied payment stating "The procedure code is inconsistent with the modifier used or a required modifier is missing".
denied payment stating "The procedure code is inconsistent with the modifier used or a required modifier is missing".
I called Medicare and the rep tells me "according to Medicare guidelines, modifier -79 is an invalid modifier for the procedure code I billed"……….WHAT ???
I explain the patient is in a post-op period, the patient received an injection into the carpal tunnel of the arm that did not have surgery which would make the injection unrelated to the post-op, I read the definition of modifier 79 "Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period"…………then she says "according to Medicare guidelines, modifier -79 is an invalid modifier for the procedure code I billed". That’s all she keeps telling me and I just can’t with her any longer. This has happened once or twice before too and we never got paid.
Am I missing something??? Am I the only one this has happened to??? Please HELP!
Thank you
Jen
“diagnosis inconsistent with the procedure”
I am getting this message from one of our state medicaid MCOs in reference to the diagnosis code associated with an E/M CPT. the CPT is 99214 and the diagnosis code is Z33.2. What are the rules for pairing DX codes with CPT codes? I thought when an E/M is done, and a decision for surgery(minor) is made for the same day, the DX code for the procedure could be attached to the E/M code. Am I missing something?