Denied E/M Code

Hi,
Medicare denied CPT® code 99213. together with CPT® code 69210. They paid 68210. The dx code 715.91 , 715.26 , 722.10 and 380.4.
I applied 380.4 to CPT® code 68210.
And 715.91, 715.26 , 722.10 to CPT® code 99213. But they denied it.
The denied code: CO97 : The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 7/1/2010: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

What should the best way to do.
Thanks

Mar 19th, 2012 - rphelps 615 1

re: Denied E/M Code

Did you put a 25 modifier on 99213?

Mar 19th, 2012 - rhina 52

re: Denied E/M Code

No, I didn't.. Is it different identifiable

Mar 19th, 2012 - rphelps 615 1

re: Denied E/M Code

Yes. There is no 68210 procedure code.

Mar 20th, 2012 -

re: Denied E/M Code

99213-25
69210

I bill this frequently. As long as you have the 25 modifier and the dx to support the wax removal, you should be fine.

Apr 13th, 2012 - rhina 52

re: Denied E/M Code

Yes.. It should be 69210-- cerumen removal. typographical error.
sherryleigh----Your saying that Medicaid accept the code?

Apr 13th, 2012 -

re: Denied E/M Code

You were asking about Medicare, right? Medicare will pay it if you as long as you have the 25 modifier on the office visit and the 380.4 dx. It would probably depend on the state as to whether it's a covered service for Medicaid.

Apr 17th, 2012 - rhina 52

re: Denied E/M Code

Got it. Thanks.