Wiki 92133/92134 being denied from Medica...

[karihassa2011]

Recently we have been getting denied for 92133/92134 when billed with 99212 or 99213. Can someone tell me if I am suposed to bill the E/M code with 25 modifier? Is anyone else having this problem with Medica?

Thanks.

 

[karriedemas@yahoo.com]

Check diagnosis

you do not need a 25 modifier on the E/M code. make sure you don't have any modifiers on 92133-92134. Also check the LCD policy with medicare and make sure you have a diagnosis for medical necessity.

Hope this helps

 

[MarcusM]

Use the LCD. It is very helpful and let your provider know what it indicates to confirm proper dx code.

 

[Coder852]

Check your CCI edits. Some testing is bundled. I cant remember if it is leve 1 or 2 that bundles with the test.

 

[annawade13]

Check your CCI edits. Some testing is bundled. I cant remember if it is leve 1 or 2 that bundles with the test.

It's only 99211 that's bundled with the tests.

 

[AlaskanCoder]

What is the denial reason you are getting from Medicare?