Medical Billing Forum
Coding => Coding => : shanbull May 27, 2014, 02:55:56 PM
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I billed 97014 for one of our physical therapists as usual, if it is accepted it will be bundled anyway but I need to know the answer on this because sometimes they bill this code alone. It was rejected for " CO-189: 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service " and "M81 - 'You are required to code to the highest level of specificity.'"
Now this is bizarre because I've never seen this response from this insurer, and we bill them daily with this CPT code, and it did have the GP modifier to indicate it was performed under a PT plan of care. I know they don't want G0283 instead. I would think perhaps the diagnosis was what wasn't specific enough (719.45 - joint pain - pelvis) but the denial specifically says it's the procedure code that is the issue. Did I miss something major about electrical stimulation codes recently?
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Who is the carrier? Is it a Medicare Advantage Plan? Sounds like they are looking for the G0283 but you seem to think they are not, how come?
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Shannon..Are you still within the cap period of $1920 (assuming this is Medicare)?
Doubt that the above is the issue but there is a list of dx codes that are covered for Medicare PT somewhere. I tried to find it but couldn't but have used it as a resource before.
Merry
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Ah Michele, you were right, it is a Medicare Advantage plan. It's through UCare and we don't get many of those so the front desk just adds them as normal UCare plans. I don't think other states have UCare, it was created to administer our MinnesotaCare insurance (basically we expanded Medicaid several years ago and people who make more than Medicaid allows get MinnesotaCare). The Medicare Advantage plans and commercial plans for UCare are new this year. We need to think about a better way to differentiate all these plans now that UCare has diversified!
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The Advantage plans are not obvious and they do require some differences compared to the other commercial plans. They are difficult for us as well! >:(