Wiki Payment Reversal - Help...

ABridgman

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We have a patient who regularly gets Dialysis in an End Stage Renal Disease facility - svc. location 65.

He was billed the normal 90960 for the month of July - this is a once a month code.

Meanwhile, during the month of July, my doctor happened to follow up on this patient in the hospital when covering for an Attending Physician, norally this is billd 99233.

Medicare is now rejecting the 99233, saying "Same Date Of Service As Previously Processed Claim For This Patient."

They have bundled the monthly dialysis bill code 90960...and are now rejecting the 99233 because of this, because it happened in the date span of the 90960 billing.

Is there some modifier I should have used to separate these somehow? I have never before encountered this situation.

I'm not sure the 25 modifier applies in this case...as it would for example...if one had an office visit - say 99214 and an ear syringing, 69210 on the same day.

This is ENTIRELY different. So not sure the 25 modifier would work here. Ideas?
 
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