Wiki Denials for 93042 with 99223

[baroquecoder]

I am seeing a lot of denials from the earlier part of the year for a 93042 when ordered in the inpatient setting. Has anyone else experienced this? Biller is telling me to put a modifier 59 on it. Any advice would be appreciated. Should mod 25 go on it?

 

[dferree37]

Is there a specific payer denying? What is the reason code?

 

[baroquecoder]

93042 with 99223

Medicare, reason code: B15 procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.

 

[dferree37]

If you are only seeing this for a specific time frame, perhaps you MAC had an issue that has since been resolved. I would contact them for clarification.