Medical Billing Forum
General Category => New! => : Logeshkumar July 28, 2016, 07:20:47 AM
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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.
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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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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.
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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
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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.
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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
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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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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.
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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?
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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?
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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?
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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.
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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?
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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.
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It does. thank you so much for your help. Have a great day.
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Hi, I am having a similar problem with Medicaid as primary cpt code 99213 and denial CO151 no remarks. this is the first visit in over an year. I look at the units and is just 1 unit so definitely is not an unit issue. does anybody knows what could be the problem? for some reason with Medicaid I get a lot of denials that do not happen with other payers including Medicare. we are locate in South Carolina so I verified the LCD before asking and is not a problem either :(
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I'm not familiar with SC Medicaid but in NY they have a certain number of visits they can have in a year. If they go over that number the provider must complete a Threshhold override form to request additional visits. It sounds like it might be that.
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Thank you so much Michelle. They finally reach out to me. The problem was that we have the incorrect carrier code under the claims. So everything look like a completely different denial when in reality was something as simple as correcting the 3 digits carrier code. :) oh boy.
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That is unfortunately common to receive a denial that is completely different than the real reason.
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The advise by Sriram_Sub is NOT advice I would follow. I'm upset that other's have not broached this subject.
Do not ever take advice from a coder or entity that is based offshore.
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