claim denial

  1. B

    Wiki Pathology

    These are the denial reasons from BCBS KC and BCBS OOS and all are for CPT 88305. There are 3 different denial reasons depending on where you look. All the claims are from July. This denial is what is on the BCBS website for claims, "Procedure is inappropriate for patient age" This denial is...
  2. C

    Wiki Medicare denying claim for missing procedure modifier

    Last Update: My supervisor says she doesn't want me doing denials. At least, not yet. It was a co-worker who had asked for my help in getting it done. I had wanted to try doing denials anyway, but since I was dropped into the deep end without a float, I felt frustrated and stuck when the...
  3. J

    Wiki CPT 11102 & 11103 denying as in global/apart of another procedure

    Hello, I have a few claims from particularly Premera and Amerigroup - but they are denying CPT codes 11102 & 11103 when billed together, even with no office visit or other procedure. I called in to ask and I am told there is a CCI edit but I find no edits between these two codes. Is anyone else...
  4. S

    Wiki Need help why Medicaid-AL been denying CPT 36902

    Hello, we billed 36902 by itself and MCD-Alabama has been denying it for " M49: Missing/incomplete/invalid value code(s) or amount(s). N59: Please refer to your provider manual for additional program and provider information." ANyone help me please...Thank you.
  5. A

    Wiki What are the common Claim denial reasons?

    I read somewhere that 4 out of 5 medical bills has at-least some minor error. What are the usual errors that may cause claim denials?
  6. G

    Wiki United Healthcare/Optum Claims Review

    Just wondering if anyone else is getting claims reviewed through Optum that are completely inaccurate? Procedures that are clearly in the operative notes denied, separate procedures bundled inappropriately, procedures denied as "size of defect" not documented although its right in the operative...
  7. J

    Wiki ICD 10 N60.19 - claim denial

    I'm hoping someone can give me some insight and help with this issue. The patient is “14 year old with Diffuse Cystic Mastopathy”, and we have coded the claim with ICD 10 N60.19. Insurance is denying because the patient is not “Age 15-124 year old”. Is it proper to add a "P" e.g. N60.19P...
    • jvenham
    • Thread
    • claim denial diffuse cystic mastopathy icd 10 n60.19
    • Replies: 2
    • Forum: Diagnosis Coding
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