Forum - Questions & Answers

Jan 12th, 2011 - sreshta 45 

Need help in solving this denial

Hi, I billed an office visit(99213) and removal of impacted cerumen(69210). I got denial for 99213 stating "this charge is included in surgical anesthesia fee". I gave modifier 25 for 99213 and also had a different diagnosis for both procedure codes. Previously i used to get this denial for 99213 when i billed 99213 with 69210 and 92504. I thought it is because of 92504, but now i didn't do 92504. I did 99213-25 and 69210. I used to get payment for both the procedures 99213,69210 and denial for 92504 in 2009. From 2010 Medicaid is paying for 92504 and denying 99213. I'am wondering why it is paying for 92504 and denying 99213. I asked a few friends of mine, they told me that "medicaid is paying for 92504 instead of 99213 however we are getting payment so leave it". But my problem here is, Medicaid is paying around 16 dollars for 92504 and it pays $33.95 for 99213 a major diffiernce in payment. So, can anybody suggest me how to get out of this. Any help would be appreciated.....
Thank You

Jan 12th, 2011 -

E&M with procedure and Medicaid denial

Review the billing policies for Medicaid in your state. Many state Medicaid payors will not reimburse an E&M and a surgical procedure on the same day. It is not uncommon to see this type of denial from Medicaid, however since Medicaid is state run, you must review your Medicaid policy rules.
Mary

Jan 12th, 2011 -

two choices

Stop taking Medicaid and send them a message about their policies, or if the visit was for an unrelated issue, tell the patient they must return on a different day for the ear wax.



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