Medical Billing Blog: Section - Denials

Archive of all Articles in the Denials Section

This is the archive containing links to all articles written in the Denials section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

Code Designations Determine When to Use Modifier 59

When do I use medical billing modifier 59? This is a great question. It is one that many don’t ask, but most don’t know the correct answer to. One of the most important things to know about the medical billing modifier 59 is which code on which to append it. There are some basic medical billing rules that can teach you which code to use with modifier 59. The general assumption about modifier 59 (Distinct procedural service) is that it should be linked to the lower-valued code of the pair. Although this may be true a lot of times, it is not always true. There is a much better rule

By: Melissa Clark, CCS-P, RT - CEO
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Gastric Bypass Codings Becoming More Common

As a medical biller, you may be seeing an increase in the number of gastric bypass claims that you are handling as more and more insurances are covering this procedure as a measure to remove the patient from danger of developing more serious, chronic and costly illnesses that can stem from being grossly obese. After a patient has undergone gastric bypass surgery, eventually they will have the band removed. Many medical billing professionals are amiss at whether to include modifier 59 with their claim in order to obtain reimbursement for the procedure. Under The Correct Coding Initiative (CCI), normally the procedure of removing the band and port removal would be

By: Melissa Clark, CCS-P, RT - CEO
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Can Your Practice Benefit From the Auditory Rehabilitation Boost?

The Centers for Medicare and Medicaid Services have recently made it known that the reimbursement for procedural code 92696 is going to be increases by a rather large amount. To clarify a little bit further, the reimbursement to providers for such a procedure will come in at approximately four times the amount being received currently. This should make any of the providers of language, speech and hearing much happier when it comes to medical billing. This entire thought of reimbursement may be a lot clearer if it is broken down a bit. For example, the code 92626 which is known for the description of Evaluation of Auditory Rehabilitation Status; first

By: Melissa Clark, CCS-P, RT - CEO
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Coding Chronic Pain Syndrome

“Chronic pain syndrome” can be considered as a vague description of a vague diagnosis by your carrier and unless you back up your medical billing with the reasons for using this catchall term for several pain conditions, you may be seeing only partial reimbursements to denials for this condition. Traditionally, ICD-9 directs you to code 338.4 (Chronic pain syndrome) for the condition. However, you may need to couple this diagnosis with other probable causes backed up by symptoms and doctor’s notes. Other diagnosis possibilities for chronic pain syndrome include fibromyalgia/muscular pain (729.1, Myalgia and myositis, unspecified); reflex sympathetic dystrophy/regional pain syndrome (337.2x, Reflex sympathetic dystrophy) or peripheral neuropathy (337.0, Idiopathic

By: Melissa Clark, CCS-P, RT - CEO
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Questions About NCCI Edits for Unusual Situations

There have been questions regarding the use of carotid Doppler (93880) being performed on the same day as venous Doppler (93965, 93970, 93971); some insurance companies do not want to reimburse both procedures as it is unusual to perform both with one service period. National Correct Coding Initiative edits don’t prevent you from reporting these codes together, but the payer may be questioning the medical necessity of performing both services on the same day. Doctors don’t usually order both of these exams for the same patient on the same date of service. If there was a reason and you can show hard documentation as to the necessity of having both

By: Melissa Clark, CCS-P, RT - CEO
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Sick Visit Claims Could Be Costing Your Practice

Did you know you might have a cash flow leak and not know it? It’s not uncommon for practices to file medical billing claims without meeting requirements for the use of Modifier 25 in bundled sick claims and doing so could very well be costing your practice valuable reimbursement revenue. Fortunately, there are some simple rules to follow to ensure that you’re getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and

By: Melissa Clark, CCS-P, RT - CEO
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Neonatal Dilemma – Should You Have Separate Charges for Separate ...

The smallest patients can present the largest and most confusing problems in medical billing. There can often be confusing scenarios that occur during neonatal procedures that many medical billings can find confusing. It could be due to the fact the patient is so tiny that many of the procedures seem related to split out but in many cases, claims for neonatal services are incorrectly bundled together. A good case in point would be if a neonatal patient presented with a fever. The physician then did a urine catheterization (51701) and a spinal tap (62270) in the office. In many cases, the medical biller might have bundled these claims together but

By: Melissa Clark, CCS-P, RT - CEO
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Increase Your “Foreign Body Removal” Reimbursements

Most foreign body removal procedures are pretty black and white. Only on the rarest of occasions is there a complication and most of the claims can be handled in a similar manner. However in the even the physician is called on to perform soft tissue removal in a FBR procedure, you need to know how to code your medical billing claim s so your reimbursement won’t be paid only partially or denied. Make sure in this event you code the service with 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated). Some giveaways that the FBR procedure was more complex than normal will be found in notes and procedurs

By: Melissa Clark, CCS-P, RT - CEO
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