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99213-25 and 11900 billed on the same day

Medical Posted Thu 26th of June, 2014 16:33:24 PM

CPT 99213-25 and 11900 billed don the same day Medicaid denied for the following reasons.

-Insurance states the following Adjustment Reason(s):
Payment is included in the allowance for another service/procedure.

-Medicaid denied The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

SuperCoder Answered Fri 27th of June, 2014 02:43:37 AM

Did they denied both the codes or only E/M visit?

If they have denied only E/M visit then, it may be because evaluation and management service performed on that DOS was not significant, separately identifiable from the other procedure performed by same provider i.e. 11900.

Thanks !!

Medical Posted Thu 03rd of July, 2014 15:37:50 PM

They denied both. Dow e resubmit using a 59 modifier for CPT 11900?

SuperCoder Answered Fri 04th of July, 2014 03:53:49 AM

Did you billed any other code on the same day or few days before this billing? Have they specified in their denial which other another service/procedure they are referencing to be already adjudicated?

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