Wiki Need help with a claim denial

[june616]

The dx are:

257.2 (hypogonadism, testicular)
V04.81 (vaccine for influenza)

I coded:
96372 (for dx 257.2)
90471-59 (for dx V04.81)
90658 (for dx V04.81)


We never code the testosterone med along with 96372 because the pt supplied the medication himself and we do not bill the ins for that. The ins denied 96372 due to coding error. Any help for where I went wrong? The dx pointers on the claim are linked with the correct dx also.

 

[kathy a]

You need to get rid of the 59 modifier.

 

[mitchellde]

Many payers will not reimburse the admin code unless the drug is also indicated. Because if they do not cover the drug they will not cover the admin. So when the patient supplies the drug we will list the J code with a 0 charge or a .01 which is adjusted off .

 

[marla3376]

I agree with Debra. I have had girls doing this also. If you bill out for the medication J-code along with 96372/KX (patient supplied own meds) you should be able to get this paid.