Wiki Help Please on denied claim

[Kar116]

We billed this claim in our pediiatric office as follows:

99391-25
36416
S3620-32

The insurance company (commerical payor) denied the S3620 as "Procedure code is inconsistent with modifier used or a required modifier is missing."

I tried 33 the first time around on the newborn screening and denied and thought the 32 would take care of it but it didn't obviously. Any solutions for me out there? I posted a similar question under the Billing and Reimbursement section but no responses were posted.

 

[mitchellde]

if the payer accepts the S codes then no modifier is needed. The 33 is for services not identified as preventive in the description but is being performed for preventive purpose, and the 32 is for a mandated service. Neither modifier is appropriate for this scenario.

 

[Kar116]

Thanks Debra. The doctor codes her own when she bills and has always used the HCPCS code for the newborn screening and it has always been denied. Seems like we should bill with a corrected procedure code instead of the S3620 code. Thanks for your help.

 

[mitchellde]

generally the S codes are for Medicaid and rarely accepted by other payers.

 

[Kar116]

They are all for the Medicaid patients and are getting denied. Thanks for the info.