Wiki 99214 and G0439

[maribel8395]

I am getting rejections at the clearinghouse for 99214-25, G0439-25, and J3301,96372

ACK/RETURNED - Returned to Entity. Usage: This code requires use of an Entity Code. - Submitter			Payer
SMARTEDIT PATTERN 24078 PER MEDICARE CCI GUIDELINES PROCEDURE CODE 99214 HAS AN UNBUNDLE RELATIONSHIP WITH HISTORY PROCEDURE CODE G0439 ON LINE ID 1 AND CLAIM ID 3E46JK4GP83 215363 20230926 4FC823E19FDDC8F08BE7D3218192BA4F6BE831AF. REVIEW DOCUMENTATION T			Payer

I called Medicare and they say since it was rejected at the clearinghouse they couldn't help me. In August I was sending claims in and getting paid just fine for this combo of codes

 

[midnight1995]

Medicare (All Jurisdiction) Posted on the websites for Smart Edits: If you review your Medicare Jurisdiction it provides the Smart edit pattern number and the next steps.
1.) Novitas (Texas) https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00275505
a.) In the link above click on the additional link Novitas Smart Edit list (Part B): this provides the Patten 24078: Detail Information: This edit will set when the services submitted are bundled per Medicare Correct Coding Initiative (CCI). Review the claim and determine if a modifier should be added, resubmit with appropriate modifier, or resubmit after 24 hours.
I have had this save Smart Edit and what this edit means is G0439 should not have the modifier 25 and if you run the NCCI edits 99214 should only have the modifier 25