Medical Billing Forum

Coding => Coding => Topic started by: PT Biller9200 on December 07, 2017, 12:40:29 PM

Title: HCPCS coding question
Post by: PT Biller9200 on December 07, 2017, 12:40:29 PM
Hello,
I am having issues with a claim denial due to "invalid combination of HCPCS Modifiers". We are a Physical Therapy office, so we have a short list of procedure codes that we bill, and I haven't had an issue with HCPCS mods before.
ICD 10 codes are: M25.632, S52.532A
Treatment codes are:
97530-59
97140
97110
97010
I can't find an applicable rehabilitation HCPCS codes...
Are HCPCS modifiers based off of the Diagnosis Code?
I'd appreciate any help I can get.
Thanks
Title: Re: HCPCS coding question
Post by: Michele on December 07, 2017, 07:19:42 PM
What insurance carrier is it?  Without knowing a bit more I would advise to contact the insurance carrier and ask them to explain the denial.  Based on the information you gave there does not appear to be any modifier issue.
Title: Re: HCPCS coding question
Post by: PT Biller9200 on December 12, 2017, 11:32:56 AM
The insurance company is BXBS.
I have already made phone calls and told them it appears to be a clean claim and I need more information about denial and what is flagging it. The response is, "we aren't coders and are unable to advise you in anything regarding billing and coding".
Title: Re: HCPCS coding question
Post by: Michele on December 13, 2017, 07:19:43 AM
I think it is in how you are wording your question.  You need to ask them to explain the denial because you don't understand it.  You aren't asking them to "code or bill" you are asking them to explain the denial code.  Are they paying some of the codes but denying others or are they denying the entire claim?