Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

10040

Geena Posted Thu 03rd of November, 2011 17:16:04 PM

Recently,we received a denial EOB for CPT 10040 with diagnosis 706.1 or 706.2 as " SPLIT SURGICAL SERVICES INAPPROPRIATLY CODED". What is the wright coding?

SuperCoder Answered Fri 04th of November, 2011 03:15:02 AM

Please check if any surgical CPT codes billed within previous 90 days, and what are those CPTs ?

Geena Posted Fri 04th of November, 2011 16:08:51 PM

We billed 10040 on 8/13/11 and 9/14/11. We got the payments.
I called the insurance , insurance rep just said that this is wrong coding.

SuperCoder Answered Fri 04th of November, 2011 17:50:40 PM

The denial statement that you mentioned first can also come when,
1. the present CPT is in the global period of any other CPT billed previously;
Or,
2. the present CPT is in the global period of SAME cpt billed previously;
Or,
3. different physicians perform the pre-, intra-, and post-operative portion of 90-day procedure, and each reimbursed at certain percentage of the global fee.
*
So, may be that the present CPT 10040 is billed within 9/14/2011 to 9/23/2011, and hence denied for reimbursement.
Plz confirm if this matches your case or not.

Geena Posted Wed 09th of November, 2011 16:37:31 PM

Nothing else was done beside 10040. We got payments for services that done before October. Since October, all 10040 were denied from this insurance which is Wellcare. I spoke with diferent rep, but no answer for the deniel. Is there any changes that we not aware of?

SuperCoder Answered Wed 09th of November, 2011 17:25:36 PM

Although you provided almost all info the best way possible, but as I can't see the reports, their sequence and other info. So, it's difficult take a correct decision. Probably there is some info gap.
*
But, I can suggest you trying with 78 modifier with all these 10040 and let me know the results.
***
One additional thing. Many times the denial reason comes wrong. Check the diagnosis codes if matches with the corresponding contractor's LCD list.

Related Topics