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CODE IS INCLUDED/INCIDENTAL TO MAJOR SERVICE

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Nmanju:


Hi,

I had submitted a claim to vista health plan, an office visit code (99214)with 25 modifier and pulse oximetry,single (94760) with 59 modifier. It denied the second line saying "CODE IS INCLUDED/INCIDENTAL TO MAJOR SERVICE " but i have noticed that they have paid for the same codes on several other claims. I also spoke to vista representatives about this but never received an appropriate explanation nor they are sending the claim for a review. Please help.


Thanks in advance.


Manju

Michele:
Since you say you have examples of the same carrier paying for the codes the only thing you can do is call back, ask for a supervisor, or 2nd level appeal.  Show them the examples of the paid claims, and your denial and ask them to explain why they are processed differently.  It may be that even though they are the same carrier, they are different plans. 

Good luck

Michele

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