kristy2
Contributor
I have a problem with my VA billing for acupuncture visit. Provider is rendering 60 minutes of services. Claims are coded as 97810 for the first 15 minutes and 97811 x 3 units (no modifiers) for the full 60 minutes.
VA has paid the 97810 but is denying the 97811 with the following denial message "This service does not meet VA CCN criteria. PER MEDICARE'S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR PROCEDURE EXCEED THE ALLOWED UNITS."
I have tried locating guidelines for the proper billing for Acupuncture on both VA CCN and CMS websites and all I have been able to come up with is medical necessity criteria. There is nothing indicating proper coding guidelines.
I researched the Medically Unlikely Edits and found that 97811 has a MUE value of "2" and "3 date of service Edit: clinical", however I don't know what this means! Can you not bill a 97811 with 3 units?
I have tried calling, I have tried written appeals with documentation that the coding is correct and they just keep telling me "97811 was properly denied per Medicare Unlikely Edits". They told me to consult the coding department, but I AM the coding department. Can anyone help guide me????? Thankyou in advance!
VA has paid the 97810 but is denying the 97811 with the following denial message "This service does not meet VA CCN criteria. PER MEDICARE'S MEDICALLY UNLIKELY EDITS POLICY, TOTAL UNITS BILLED FOR PROCEDURE EXCEED THE ALLOWED UNITS."
I have tried locating guidelines for the proper billing for Acupuncture on both VA CCN and CMS websites and all I have been able to come up with is medical necessity criteria. There is nothing indicating proper coding guidelines.
I researched the Medically Unlikely Edits and found that 97811 has a MUE value of "2" and "3 date of service Edit: clinical", however I don't know what this means! Can you not bill a 97811 with 3 units?
I have tried calling, I have tried written appeals with documentation that the coding is correct and they just keep telling me "97811 was properly denied per Medicare Unlikely Edits". They told me to consult the coding department, but I AM the coding department. Can anyone help guide me????? Thankyou in advance!
