Author Topic: Medicare - CO151 - Payment adjusted because the payer deems the information  (Read 7277 times)

Logeshkumar

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Medicare denied stating " CO151 - Payment adjusted because the payer deems the information submitted does not support this many/frequency of services" . Please give some solutions.

Michele

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There is no way to advise you without more information.  You didn't even provide what the service was??
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kristin

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This code is usually used when either too many units of something was billed for one DOS, or when something is only allowed to be billed X amount of times in a given time frame. Need more info, like Michele says.

Sriram_Sub

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It is not easy, my friend. You have to be more specific when you are requesting for help. No one in this world can recommend a firm resolution without having more information about the Claim and the services.

I guess, you have not worked in denial management before, but have been asked to handle denials by yourself. If so, I pity you. We will help you for sure. But need more info.

Regards
Sriram
Sriram

chandru_2k15

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You may check UOS (Unit of sevices) on CMS website for possible solutions to denials pertaining to number of units.

Thank You,
Chandru J.

rhina

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I got same denial from Medicare 151 :  Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Cpt J7322--units-96

Michele

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Did you check the LCD/NCD for J7322?  I'm showing that J7322 is a deleted code.
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Sriram_Sub

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I tried to attach a document that I downloaded from google but for some reason I could not attach. It said that J7322 1mg equals 24 billing units. Probably you should change your measurement for this HCPCS code from Units to MG so that you can bill 4 Mgs which equals 96 billing units. I don't know if your software allows you to specify unit measurement. If yes, you may try using 4 as the mg units which means 96 billing units.
Sriram

tperian

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I am trying to bill G0439 and getting the same message.  The units equal 1 and it has been over a year since the last time it was filed.  Any other suggestions?

kristin

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Was your office the last to file the AWV? Is it possible it was also recently billed by another office that you are not aware of?

tperian

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That is entirely possible.  How do we avoid this since the patient wouldn't know that is what the other physician charged?  Do you suggest we recode the claim and refile it or would it be better to cut our loss?

Sriram_Sub

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If it is a scheduled appointment, you may verify benefits with the payer and see if your plan of Annual wellness care would be covered. By then, you would know if someone has already billed for that service during the same year.
Sriram

tperian

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Thank you for your help.  Since the HPI states that the patient was here for his annual wellness check, i would not be able to re-code this visit as an E&M.  Correct?

Sriram_Sub

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For the current charge, you may change the CPT and ICD code if the chart notes (by any chance) has been documented with some diagnosis other than Z00.00 or so. This way, we may justify that the patient was given a consultation for a problem and that it was not a AWV.

For your future AWV charges, I would suggest to have their eligibility verified so that the reps can advise if the patient is eligible to get a AWV consultation given for the year. Hope this helps.
Sriram

tperian

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It does.  thank you so much for your help.  Have a great day.