Forum - Questions & Answers

Sep 1st, 2015 - alpjeffrey 14 

96372 denial

I have a lot of denials with this code and I don't really know how to fix it. I don't actually put the codes in before they are sent to my clearinghouse. I end up seeing the rejections. So here is what the "check out girl" put in.

99214 - 25
81001
51701
74000 - 59
96372 - 59
J1580

I'm horrible with modifiers but I'm thinking two -59's won't pass through to Medicare (?). This claim's line items that are rejected are the 96372. For some reason the J code was left off completely when it got sent through. I'm having a lot of issues with the person who is supposed to be putting the charges in. Anyways, it's denying for "Not covered when performed during the same session/date as a previously processed service for the patient." Can someone explain this rejection to me? I get it alot and don't quite understand it really.

Sep 1st, 2015 - chriskhans 2 

re: 96372 denial

They probably want to know what drug was injected. They won't pay for an administration if the drug code isn't listed.


Also codes 51701,96372 are bundled so a modifier is necessary

The procedure codes are part of the NCCI edits. Use of modifier(s) is allowed.
Procedure (51701) is in Column One and procedure (96372) is in Column Two in the NCCI Edits. You can use modifiers to provide additional information about the sevices rendered. Modifiers may be appended to HCPCS/CPT® codes only if the clinical circumstances justify the use of the modifier.



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