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RE: [MedicalBillers] Unbundling Proc w/Blue Cross?

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  • 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 1 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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