Wiki E&M and Sonogram on Same DOS

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dan528i

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Hello,

Can someone please help.

I have a UHC (NY) and ONLY UHC denying 99213 when performed on same DOS with 76830 and DX code 626.0. I've been trying to prove to them thats an error denial but they are insisting that they processed the appeal correctly. I want to make sure that I m correct before sent this to the DOI.

THANKS
 
Dx billed is fine There may be a modifier issue in this claim.....what is the place of service?
Thanks
 
are you using 626.0 as a dx to confirm pregnancy? Remember 626.0 is a dx code to indicate a disease or disorder of the genitourinary system, A condition of abnormal bleeding. Not as a symptom of a possible pregnancy dx. It needs to be an absences of menstruation for a period of 6 months or greater or a female under 16 that has never had a period.... Look at V72.4x for examination or test for pregnancy. This may not be the issue with your chart at all but I thought I would bring it up.
 
Uhc

UHC added claims edit in their system , If you billed and EM code with a USN code you need to add 25 modifier to the EM, and that both code has seperate medical records.
 
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