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CPT 99213-25 and 11901

Medical Posted Tue 30th of December, 2014 14:55:28 PM

We are getting the denial below when we bill CPT 99213-25 and 11901 pointing to DX 704.01. We are also billing 704.00 as primary DX not pointing to a CPT.

Molina insurance Denied as “This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)”

SuperCoder Answered Wed 31st of December, 2014 00:28:20 AM

What diagnoses does provider mentions in medical records for which he is performing intralesional injection ?

Intralesional injection for treatment of alopecia does not seems to be appropriate. You should use the appropriate diagnoses from cross walk of CPT code 11901, which corresponds to diagnoses in medical records.

Thanks !!

Medical Posted Fri 02nd of January, 2015 11:13:12 AM

The provider's assesment notes states Alopecia Areata on elidel/mometasone refill meds continue improving ILK today 2.5 cc of 20mg/cc.

SuperCoder Answered Mon 05th of January, 2015 03:15:41 AM

The diagnoses and procedures codes are correct based on provider's documentation. You should call the payer and ask for specific denial reason.

Thanks !!

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