ollielooya
True Blue
Trying to plot a course of action for the three line submittal received by one of the family practice physicians solo practice for a Medicare claim:
17000 (702.0) denied with CO-96 (1 unit)
17000-59 (702.11) denied with CO-96 (1 unit)
17003 (702.11) paid ) (5 units)
Line 1: I see where the first line item should have the modifier 59 on it or the XS, and that might clear up that particular charge?I pulled up the Noridian
LCD and it's a little quirky on the inclusion of this code. It is not in the format of accepted codes, yet it is included in an explanatory note at the bottom of the accepted codes implying that it is.
Line 2: probably should remove the modifier on this one altogether?
Line 3: This is an add-on code and I'm surprised that it was processed at all since the dx is the same as for line #2 which was denied. However 5 units were billed and the paid amt. was only 23.91 Allowed amount was $30.50 of which $23.91 was paid. Thinking maybe it should be broken down into separate lines of the 17003 with one unit each with appropriate XS modifier?
Just not sure how to format a phone reopening/correction properly in order to avoid the appeal process
17000 (702.0) denied with CO-96 (1 unit)
17000-59 (702.11) denied with CO-96 (1 unit)
17003 (702.11) paid ) (5 units)
Line 1: I see where the first line item should have the modifier 59 on it or the XS, and that might clear up that particular charge?I pulled up the Noridian
LCD and it's a little quirky on the inclusion of this code. It is not in the format of accepted codes, yet it is included in an explanatory note at the bottom of the accepted codes implying that it is.
Line 2: probably should remove the modifier on this one altogether?
Line 3: This is an add-on code and I'm surprised that it was processed at all since the dx is the same as for line #2 which was denied. However 5 units were billed and the paid amt. was only 23.91 Allowed amount was $30.50 of which $23.91 was paid. Thinking maybe it should be broken down into separate lines of the 17003 with one unit each with appropriate XS modifier?
Just not sure how to format a phone reopening/correction properly in order to avoid the appeal process
