Medicare rejected 97606 Help!

[MBP]

here is my quite complicated claim could someone advise? Dx 877.1, 780.97, 995.91, 518.81

Pt was in the hospital for over 3 weeks. The doc is a surgeon..

99255 (5/14)
15936 (5/15)
99291 mod 25 (5/18-5/29)
97606 mod 58 (5/20, 22, 25, 29, 6/1, 2, 3)
99232 mod 25 (5/30)
99291 (6/1-6/10)

Medicare denied 97606 for 5/29 and 6/1, 2, 3 with the reason procedure inconsistent with the modifier used or a required modifier is missing..

[Michele]

Try this website

http://www.wpsic.com/medicare/part_b/education/modifier_58.pdf

Michele

[MBP]

thank you Michele!

[Priyan]

Erika:

   Billing is correct, 99291 Critical care should go along with MOD 25 when other service being done on the same DOS.

But, ensure you are indicating diffent diagnosis codes for both the services in HCFA

For ex: 99291 with diag pointer 1 and 97606 with Diag pointer not related to primary.

Only, this will make Insurance to understand that wound assesment has no relavent with the critical care billing

Thanks
Priyan.D