36415

i m recieving a denial of 36415 from qualchoice as incidental procedure please help me how to get ride of this problem

36415

There is an article in Codapedia about denials with the word "incidental" rather than bundled. Take a look at that.

This is probably going to end up being a contracting issue. Their claims editing program is including it as part of the E/M service, which it is not.

You can try a 25 modifier on the E/M service, but they probably have their editing program hardcoded to deny it.

Wish there was a better answer.

36415

I would also suggest any time you re-bill using a mod 25 (or anything for reconsideration) to include notes with the claim. I worked as a claims auditor, and it was our policy to deny any resubmissions the same way as the original regardless of the modifier, unless there where notes for review. Hope this helps.

Agree

If you do what you did, you'll get what you got!

bundled with

36415 was bundeld with 85025 part of lab procedure can we get paid these codes separatly

36515 - Collection of venous by venipuncture... it may have to be medically necessary

For this code check with the insurance provider as this certain CPT code 36515, may be have to be deemed "Medically Necessary and submission of appropriate docs to support the claims. Denials are usually based off wrong diagnosis, not medically necessary, and wrong procedure. So recheck your medical records and/or query physician for more specific findings or procedure.

May it would help if you give a more depth scenario of the dx, procedure, and info to determine the appropriate code. Thanks.