Wiki Medicaid denials for ER code even after billing with 25 modifier

Create Wiki
M

meeramohanakrishnan

Networker
Messages
54
Location
Cypress, TX
Best answers
0
Good Morning!

Medicaid is denying ER code when billed with surgery. I have appended 25 modifier to ER.But still the ER is denied as inclusive to the procedure. We tried tagging different primary diagnosis with ER and surgery and denial still continues. This is for the state Oklahoma

Is there a different way of billing the above scenario to get the payment for ER as well?


Thank you
 
So many state medicaid programs have their own "system of coding". In Nevada, they don't like LT or RT or "50" so I know the challenge you are facing. Have you tried billing it with a modifier 57 - Decision for surgery. If they still deny it, I would see if you could find a "live body" to talk with or who you write an appeal to. Did the ER physician perform the surgery or did a different surgeon do the procedure? Just some ideas, as I said even thought Medicaid programs are "federally funded", many of them have their own concept of coding and with the one I dealt with in Nevada, God forbid you dare challenge them even with CPT, ICD-9 and HCPCS code books and federal regulations in hand. Good luck!!!
 
meeramohanakrishnan said:
Good Morning!

Medicaid is denying ER code when billed with surgery. I have appended 25 modifier to ER.But still the ER is denied as inclusive to the procedure. We tried tagging different primary diagnosis with ER and surgery and denial still continues. This is for the state Oklahoma

Is there a different way of billing the above scenario to get the payment for ER as well?


Thank you
Click to expand...

Try modifier 57 (decision for surgery), if your documentation supports it. Appeal it with records if it denies. ;)
 
In Kansas the straight Medicaid program will not allow any E/M with a procedure on the same date of surgery. There are some other "state" programs that do allow and the patients switch mid month etc between programs so we just bill all of them and if they do not pay we just write them off. Doesn't make sense but that's what we have to do.
 
ER provider performs a minor surgery like suture removal, debridement etc.
We append 25 modifier to ER code.But the Medicaid insurance denies ER code as inclusive in the minor surgery procedure
 
You must log in or register to reply here.
Top