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5838Unbundling Proc w/Blue Cross?

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  • Melinda
    Jan 16, 2013
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      Got a denial from Blue Cross today.

      99397 - denied
      99214-25 - paid
      17110-59 - paid
      90471-59 - paid
      90732 - paid

      Blue cross didn't put a "reason code" as to why they denied the 99397. I had to call them to discover why it was denied. They said that according to CCI edits that 99397 has an "unbundle relationship with 17110".(?)

      Pt came in for a well adult PE and then a sick visit was also addressed (99214), as he had "a list of concerns"; and then Dr. froze lesions and pt got a pneumonia shot.

      I cannot find anything on CCI about this, can anyone else? Should I have billed it with a modifier? If so which one?

      http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

      Melinda Brown, CMBS
      Ins Biller
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