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;
2. the present CPT is in the global period of SAME cpt billed previously;
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.