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    Wiki 85660 Units Billed

    For facility billing 9 units for CPT 85660 are billed on the UB04 and 9 units of 86902 and 10 units of 86922. Seven units of CPT 85660 are always denied for missing/incomplete/invalid days or units. I'm aware the MUE for CPT 85660 is 2 units. Should the additional 7 units not be billed, or does...
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    Wiki CPT 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Please help me understand the requirements for billing TOB 0141

    I have received multiple claim denials from different payors for labs billed on a UB04 under bill type 0141 (Hospital - Laboratory Services Provided to Nonpatients). The claim does not include lab draw charges (36415). For example, one claim has CPT codes 87491, 87591, and 87661 billed under...
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    Wiki 76700 billed with 76775-XU

    I have a facility claim denial for CPT code 76775-XU due to invalid modifier. I'm aware procedure code 76776 is considered to be a component of the comprehensive code 76700. However, I'm questioning if CPT 76775 should in fact be billed separately based on documentation. There are TWO SEPARATE...
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    Wiki Nuclear Medicine Functional Reporting

    I have a claim for gastric emptying study (78264) billed with modifiers MG and PO and G1004 (Clinical Decision Support Mechanism). There is also a charge for lab 82962 and contrast agent (A9541). UHC Medicare denied the claim stating CPT code 78264 requires functional reporting. It's my...
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    Wiki Facility Billing G0108

    I have received multiple claims that denied HCPCS G0108 for Diabetes Self-Management with a denial reason of "the procedure code/type of bill was inconsistent with the place of service". HCPCS G0108 is reported on the claim under revenue code 0942 and CPT codes 83036 and 82962 are billed under...
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    Wiki Modifiers LD & LC

    I'm a utilization nurse reviewing a denial for missing modifiers. Procedure codes billed are 92928 x2, 92978 x1, 92979 x1, and 93458-59 x1. I have my CPC, but it was more so I could get some idea of some of the denials I audit. Based off what I'm understanding with the coding and the op report...
    • RaeToll
    • Thread
    • cardiac catheterization procedures pci coding
    • Replies: 1
    • Forum: Cardiology
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    Wiki Medi-Cal Newborn Reimbursement

    I realize this is a long shot but, has anyone billed newborn claims to California Health and Wellness? I've been getting denials as "payment included in allowance for another service". I reviewed the CA Health and Wellness Global Maternity Package policy; however, it does not specify if the...
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    Wiki Can I bill PI modifier with a cancer diagnosis?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki Can I bill modifier -PI with a cancer Dx?

    I received a Medicare claim rejection for CPT code 78816-PIPO (PET/CT whole body) citing inconsistent modifier or required modifier is missing. The primary diagnosis listed on the claim is C61 (malignant neoplasm of prostate). I reviewed the CMS Billing and Coding policy which states, Claims for...
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    Wiki How to bill J0741 CABENUVA

    I have a denial for HCPCS J0741 where 600 units were billed. Medicare denied stating the information submitted does not support this many/frequency of services. The order is for Cabotegravir/Rilpivirine 600mg/3mL - 900mg/3mL ER injection Suspension Kit 6 mL. The nurse documented a total of 6mL...
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    Wiki Medi-Cal Z7514

    How would you bill for observation (facility) that exceeds 24 hours? I have a claim that denied Z7514 x 2 as exceeding the benefit max. The description of the code reads, "room and board less than 24 hours". The patient was admitted to observation at 02:22 and discharged the following day at...
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    Wiki How do you bill postoperative recovery room or observation charges?

    I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code. I was thinking to remove revenue code 0710 and rebill with...
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    Wiki How do you bill postoperative observation/recovery room?

    I have a UHC claim denial for revenue code 0710 for missing the associated CPT/HCPCS code. I assumed revenue code didn't require a CPT code. The patient underwent a septoplasty and was admitted to observation overnight, for which revenue code 0710 was billed without a CPT code. I was thinking to...
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    Wiki Please Help 77300 MUE

    I am a UR nurse asked to review a claim denial for medical necessity where CPT 77300 denied as exceeding MUE. MUE is 10 units. What was billed on the UB04 is 77300 x 10 units and 77300-59 x 73 units. Are the units for 77300 referred to as "shots"? I would like to confirm I'm reading the...
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    Wiki CPT 82043 Modifier 91

    I have a facility claim for CPT code 82043 for Microalbumin, Urine Random and CPT codes 82043-91 and 82570 for Microalbumin Creatinine Urine Ratio denied by Medicare as "number of units not supported". Both orders were placed at the same time from the same provider. If anyone has experience...
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    Wiki 29581 denied for inconsistent modifier use

    United Healthcare denied a claim billed with CPT 29581-GP-RT-XS and 97597-GP and 97598-GP, stating "procedure inconsistent with the modifier used or a required modifier is missing". I have searched United Healthcare billing and coding guidelines as well as their modifier policy and outpatient...
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    Wiki CPT 29581-GP-RT-XS denied inconsistent modifier

    United Healthcare denied a claim billed with CPT 29581-GP-RT-XS and 97597-GP and 97598-GP, stating "procedure inconsistent with the modifier used or a required modifier is missing". I have searched United Healthcare billing and coding guidelines as well as their modifier policy and outpatient...
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    Wiki Same Day Admit/Discharge < 8 hours

    I have an inpatient claim with TOB 0111, denied requesting a corrected claim with a code explaining the same date discharge. The patient was admitted inpatient status at 14:50 and discharged at 17:35. Per CMS Manual Pub 100-04 Medicare Claims Processing, CPT codes 99234-99236 require a minimum...
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    Wiki Same Day Admit/Discharge < 8 hours

    I have an inpatient claim with TOB 0111, denied requesting a corrected claim with a code explaining the same date discharge. The patient was admitted inpatient status at 14:50 and discharged at 17:35. Per CMS Manual Pub 100-04 Medicare Claims Processing, CPT codes 99234-99236 require a minimum...
    • RaeToll
    • Thread
    • cpt99221-99223 cpt99234-99236 samedaydischarge
    • Replies: 3
    • Forum: E/M
  21. R

    Wiki 86923 Denial Help

    I received a denial from Anthem BCBS for CPT code 86923 stating "CPT code 86923 should be billed with the appropriate code for these services". I was unable to find any reference via CMS or Anthem BCBS website. I appreciate any guidance.
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    Wiki Inpatient Medicare Part B

    I appreciate any assistance with billing the secondary payer following Medicare Part B. Primary payer is Medicare Part B Secondary payer is Anthem BCBS Medicare Part B was billed for outpatient services with TOB 0121. Anthem was billed with TOB 0111. Anthem denied payment as the claim amount...
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    Wiki Coding a Diagnosis Based on a Query

    The payor denied this inpatient claim for the principal diagnosis of sepsis as the condition was not mentioned within the medical record, and only documented in a physician coding query. Can we bill a diagnosis based on indicators and a coding query, even if not mentioned in the medical record...
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