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Humana denials

Jenny Posted Mon 29th of June, 2015 14:08:56 PM

I've been struggling with my provider in telling patients to come back too early for lesion removals, because we were not getting paid. So, he finally started to tell them to come back after 30 days (to space them out some). I've used Modifier-24 on the claims to show unrelated service, but the denial code sts: "This procedure code was denied because this service was included in another service provided at the same time." and "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated" Did I use the wrong modifier? Any suggestions would be welcomed! Thank you!

SuperCoder Answered Tue 30th of June, 2015 02:01:57 AM

Usually the E&M service code gets included in the services of the procedure performed on the billed DOS. However, if an unrelated E&M service has been performed (unrelated to the procedure), then append modifier 25 with the evaluation and management code to suggest that an separate identifiable E&M was performed on the billed DOS.

Also, for procedures with global day of 10 and 90 days, E&M services for the same problems are not covered during the global period. However, any other problem encountered during the E&M which is different from the procedure can be billed with 25 modifier.

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