Wiki Uhc denies 93545 as bundled

[melissa10000]

Billed the following to uhc:

99254-57, 33967, 92980-rc, 93510-26, 93545, 93543, 93555-26-59, 93556-26-59, 93306

uhc paid everything but 93545, which they bundled. Why would they bundle 93545 but not 93543, and why wouldn't they pay for contrast material, yet pay for the imaging?

Anyone have a good rebuttal to appeal with?

Thanks.

 

[Jess1125]

With United Healthcare who knows why? I have found United Healthcare is one of those rare insurance companies who want a -59 on the 93545 when billed with intervention even though there are no CCI edits for it.

Addedum: If you go to www.cms.hhs.gov, click on "Medicare, under coding click on NCCI, then click on NCCI Policy Manual (updated 4/9/09). Click on Chapter 11 (90000 series) and refer to the bottom of page 12 of the file (item #10) will address the 93545. Hope this helps.

 

[melissa10000]

Thanks, but one more question

Thanks a lot, Jess. I have reviewed the material in the manual. So have you just rebilled 93545 with a -59 for this specific payer, or do you appeal with documentation, as CCI edits indicates no bundling issues?

I appreciate the help, thanks again.

 

[Jess1125]

I put a -59 modifier on the claim.

 

[melissa10000]

Thank you for the help

Thanks again!