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M80 Denial Code?

Hazel Posted Tue 15th of November, 2011 02:15:41 AM

Hello, would you please tell me if the M80 denial code by Medicare can be overridden with a 59 modifier? or other modifier? or, is Medi-care trying to tell us these procedures must be done on a different date for reimbursement.
M80 = Not covered when the performed during the same session/date as a previously processed service for the patient.
Thank you :D

SuperCoder Answered Tue 15th of November, 2011 02:52:27 AM

M80: Not covered when performed during the same session/date as a previously processed service for the patient
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I think this is a case of billing multiple E/M service on same date of service. This will only be covered if performed in different date of service. No modifier can help reimbursement if billed on same date of service.

Hazel Posted Tue 15th of November, 2011 15:31:51 PM

REPLY-
This denial code, M80 was given for CPT codes: '62311' and '20551 - 59 - LT'.
No E/M was billed on that day. The Diagnosis codes were checked and meet the LCD criteria so it's not the ICD codes.
Neither CPT was paid.
Can you assist further? Can you see if anyone else a Supercoder knows (help)?
Thanks :D

SuperCoder Answered Tue 15th of November, 2011 18:36:30 PM

The modifiers attached wrongly. Although RVU of 62311 is far higher than 20551, but as per CCI edits, 62311 is the Column 2 code for CPT 20551.
So, we need to code:
20551
62311-59
Attach LT or RT as appropriate.

Hazel Posted Tue 15th of November, 2011 20:07:40 PM

THANK YOU:D
this was very helpful!

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