Hazel Posted Mon 14th of November, 2011 20:50:52 PM
Hello, we submitted cpts: '20610', '20550-59', '20552-59'.
Diagnosis given: 715.36 for 20610, 729.4 for 20550-59, 729.1 for 20552-59.
All Diagnosis are okay based on the LCDs.
We were paid for 20610 but denied for the other cpts with B15: This procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
Can anyone assist (please) w/ what is needed? Is CMS telling us that we have to add modifier -51 here (which would result in a significant reimbursement reduction)? Thanks very much :)
SuperCoder Answered Tue 15th of November, 2011 00:37:07 AM
Sometimes the denial statement doesn't come right. Disregarding the denial statement, I think you need to avoid "Unspecified" diagnosis codes particularly with this kind of CPTs to get reimbursement.
Sometimes we need to take care in filing with correct codes before concentrating on denials. So,
please change the diagnosis codes accordingly, and if still denial comes then plz revert back to me.