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New Medicare denial

Vaida Posted Sat 22nd of November, 2014 17:45:46 PM

Florida Medicare all of the sudden started denying 96372 code that were billed with 99212 and J3301 on the same claim with a denial reason: "This service/procedure requires that a qualifying service/procedure be received and covered". I never had any issues getting this 96372 code paid. Has there been some recent changes on billing IM Injections?

SuperCoder Answered Mon 24th of November, 2014 08:59:50 AM

Thanks for your question. At this time there is no information regarding changes for billing 96372 to Medicare. Can you provide some additional information so that this can be further researched? What diagnosis was billed with each code and were any other services billed on the same day as this code besides the office visit and drug?

Vaida Posted Tue 25th of November, 2014 13:44:16 PM

Thank you so much for your reply. Usually the claims are being billed with diagnosis with diagnosis 695.89 (Granuloma Annulare). The claim has these codes: 99213 mod 25, 96372 and J3301. Everything gets paid except 96372 gets a denial CO-B15, which reads: "This serviceprocedure requires that a qualifying serviceprocedure be received and covered".
As I mentioned before, they get denied by Medicare only. We bill same codes to other insurance companies and they get paid no problem. And Medicare was never an issue to get this code paid until very recent. Thank you in advance for your response.

SuperCoder Answered Wed 26th of November, 2014 09:28:25 AM

Thanks for the additional information. There seems to be no reason for this denial. You should call Medicare and ask for clarification on this denial,there may be another issue that is causing these denials. The only other reasoning could be that Medicare wants a diagnosis code that is more specific.

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