Colliemom
Expert
Good morning,
So we have a provider who submitted a 99309, which was paid, and then she added a 99358 and 99359 to the encounter, which were denied. The claim was denied, stating a modifier was needed. First, do you all agree these were the correct codes for the services outlined below? And second, I am getting a red edit (showing the CPT codes can never be billed together, not even with a modifier) when I run these codes through our CCI edits. So do you have any experience with this?
Patient was seen for a cough, but when the APRN went into to see the patient (in a nursing facility) the patient was found unresponsive. No respirations, no pulse, CPR initiated. 47 minutes spent doing chest compressions, bagging and intermittent meds. ER physician directed the APRN and EMS to stop CPR. The APRN then called family to notify them, called the conservator, called the funeral home, D/C the body to the funeral home, and filled out the death certificate. Total time spent on the case and in coordination of care was 120 minutes.
So we have a provider who submitted a 99309, which was paid, and then she added a 99358 and 99359 to the encounter, which were denied. The claim was denied, stating a modifier was needed. First, do you all agree these were the correct codes for the services outlined below? And second, I am getting a red edit (showing the CPT codes can never be billed together, not even with a modifier) when I run these codes through our CCI edits. So do you have any experience with this?
Patient was seen for a cough, but when the APRN went into to see the patient (in a nursing facility) the patient was found unresponsive. No respirations, no pulse, CPR initiated. 47 minutes spent doing chest compressions, bagging and intermittent meds. ER physician directed the APRN and EMS to stop CPR. The APRN then called family to notify them, called the conservator, called the funeral home, D/C the body to the funeral home, and filled out the death certificate. Total time spent on the case and in coordination of care was 120 minutes.