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Medical Billing Forum
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Billing
(Moderators:
Alice Scott
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Michele
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Biller
Poll
My CPT code 66405 is denied. Cannot understand why and how to resolve this..
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Topic: Biller (Read 3271 times)
binal05080
Guest
Biller
«
on:
July 09, 2019, 01:14:14 PM »
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.
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Michele
Administrator
Hero Member
Posts: 5927
Re: Biller
«
Reply #1 on:
July 09, 2019, 04:17:23 PM »
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.
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binal05080
Guest
Re: Biller
«
Reply #2 on:
July 09, 2019, 04:33:16 PM »
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
«
Last Edit: July 09, 2019, 05:32:12 PM by binal05080
»
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kristin
Hero Member
Posts: 703
Re: Biller
«
Reply #3 on:
July 10, 2019, 08:33:54 AM »
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.
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binal05080
Guest
Re: Biller
«
Reply #4 on:
July 10, 2019, 08:57:32 AM »
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.
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Medical Billing Forum
Re: Biller
«
Reply #4 on:
July 10, 2019, 08:57:32 AM »
kristin
Hero Member
Posts: 703
Re: Biller
«
Reply #5 on:
July 10, 2019, 09:42:49 AM »
I meant anatomical location. Not POS location. Meaning were both injections given in the same place on the patient's body.
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binal05080
Guest
Re: Biller
«
Reply #6 on:
July 10, 2019, 10:20:24 AM »
Yes it was done on the same location.
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kristin
Hero Member
Posts: 703
Re: Biller
«
Reply #7 on:
July 10, 2019, 01:23:00 PM »
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.
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binal05080
Guest
Re: Biller
«
Reply #8 on:
July 10, 2019, 01:37:38 PM »
Thanks a lot . I will let you know as soon as I get reply from my ins.
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binal05080
Guest
Re: Biller
«
Reply #9 on:
July 10, 2019, 04:13:35 PM »
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.
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Medical Billing Forum
Re: Biller
«
Reply #9 on:
July 10, 2019, 04:13:35 PM »
PMRNC
Hero Member
Posts: 4562
Re: Biller
«
Reply #10 on:
July 11, 2019, 09:26:38 AM »
Just FYI.. Dates of service are considered PHI
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Medical Billing Forum
Re: Biller
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Reply #14 on:
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