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Medicare denial for 93461

Marita Posted Wed 28th of November, 2012 21:03:06 PM

Patient was admitted & same day Dr. performed Rt & Lt heart cath with bypass graft angiography.

We billed 99223 AI 25, and 93461 26.

They say there is a problem with the 93461 26 portion of the billing. This is the message I received: ~ACKNOWLEDGEMENT/REJECTED FOR INVALID INFORMATION | HCPCS Am I missing something?

Thanks,
Marita

SuperCoder Answered Thu 29th of November, 2012 15:11:04 PM

Hi Marita,

That rejection comment typically means the payer thinks the code wasn't valid for the date of service or that there's a problem with the modifier/code combo (e.g., http://www.ngscedi.com/News/ngs_082312_Top.htm).

So perhaps check the date of service. The 26 is appropriate for 93461 for the professional component. They may accept the E/M only if it was an unplanned cath. That is, the decision for the cath wasn't made on a previous day.

I hope this helps!

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