Biller

[binal05080]

Serv Date Units Serv Code Billed Paid Allowed Adjustments
06/12/2019 - 06/12/2019 1 HC:99204:25:X2 $220.00 $136.63 $171.30 CO-45: $48.70  , CO-253: $2.79  , CO-144: $-2.38  PR-2: $34.26   
    REM: N807   
06/12/2019 - 06/12/2019  HC:64405:RT $190.00 $0.00 -  CO-236: $190.00  -- Has been not approved
06/12/2019 - 06/12/2019 1 HC:20610:XS:RT $115.00 $51.29 $64.30 CO-45: $50.70  , CO-253: $1.05  , CO-144: $-0.90  PR-2: $12.86   
    REM: N807   
06/12/2019 - 06/12/2019 3 HC:J1020 $22.50 $9.16 $11.69 CO-45: $10.81  , CO-253: $0.19  PR-2: $2.34   

Can sone one help why 66405 RT is not approved from Ins.

[Michele]

There is really no way to tell from the information below since we don't have DX codes, but it looks like you are billing for two injections on the same date so the 64405 is being bundled. 

[binal05080]

Michele below is the detail based on Dx. 

HC:64405:RT $190.00 $0.00 -  CO-236: $190.00  -- Has been not approved
64405 is denied with the error ode : CO- 236.

Diag code: M54.2, M54.5, M54.81, M25.511, M25.512, M13.0M19.011, M17.0, MF41.8 & R26.2

[kristin]

Was the 20610 and the 64405 done on the exact same location? Because what it looks like to me is that the 64405 was given first as a nerve block, then the 20610 aspiration code was performed on the same site. If that is the case, you can't bill for the 64405 nerve block separately from the aspiration, as the 20610 already includes the nerve block, and is not separately payable. All you need to do for the future is look at your NCCI/CCI edits, and it will tell you this.

If for some reason the injections were given in two completely separate locations, unrelated to each other, then the problem is you are missing an XS or 59 modifier.

It is hard to say for certain what was done here, because you listed all the dx's, and didn't specify which ones of the 10 you listed go with what codes.

[binal05080]

Hi Kristin,
Yes it was done at the same location POS 11

Code     POS   TOS   SDOS           M1   M2   ICD1     ICD2  ICD3   ICD4  Units
99204     11      1     6/12/2019    25    X2    1           2        3          4       1
66405     11      2                         RT           3                                          1                                                                         
20610     11      2                         XS    RT   4                                          1
J1020     11       9                                                                                    3             


This might help you.

[kristin]

I meant anatomical location. Not POS location. Meaning were both injections given in the same place on the patient's body.

[binal05080]

Yes it was done on the same location.

[kristin]

Then my first answer stands. You can't bill an anesthetic block injection to numb the area before you do an aspiration injection, the anesthetic block is bundled into the aspiration.

If, for some reason, the anesthetic block was COMPLETELY unrelated to the aspiration, then and only then can you bill it separately, and you would need a 59 or XS modifier on it.

[binal05080]

Thanks a lot . I will let you know as soon as I get reply from my ins.

[binal05080]

Everyone thanks a lot for reading my issue and helping me to resolve the same. I did refiled the claim for the cpt 64405 with mod 59 & RT.

Thanks to Kristin for helping me to solve this issue.

[PMRNC]

Just FYI.. Dates of service are considered PHI

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