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Unbundling Proc w/Blue Cross?

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  • Melinda
    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
    Message 1 of 2 , 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
    • josette sylvan
      guessing that since 17110 is a procedure which is scheduled and or performed, how can you expect to get paid for a preventive service??? or did you not have a
      Message 2 of 2 , Jan 16, 2013
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        guessing that since 17110 is a procedure which is scheduled and or performed, how can you expect to get paid for a preventive service??? or did you not have a V code diagnosis with the preventive visit code? I really dont see anything preventive about patient's visit.
        josette

        To: MedicalBillers@yahoogroups.com
        From: melindadocsmith@...
        Date: Wed, 16 Jan 2013 22:31:28 +0000
        Subject: [MedicalBillers] Unbundling Proc w/Blue Cross?


























        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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