Creatinine (Blood) | NCCI Bundling Denials

Denial Reason, Reason/Remark Code(s) • M-80: Not covered when performed during the same session/date as a previously processed service for the patient• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.• CPT code: 82565 National Correct Coding InitiativeThe National Correct Coding Initiative…

Medical Necessity Denials & NCCI Bundling Denials

Diagnostic Cardiology Services: Medical Necessity DenialsDenial Reason, Reason/Remark Code(s) • CO-50, CO-57, CO-151, N-115 – Medical Necessity: An ICD-9 code(s) was submitted that is not covered under a LCD/NCD• CPT codes: 93307, 93320, 93325 Resolution/Resources • Refer to the ‘Transthoracic Echocardiography’ Local Coverage Determination• If the service being performed is not covered under the LCD guidelines, we…

Code/Modifier Combination Invalid & Modifier Invalid/Missing

Code/Modifier Combination Invalid and Modifier Invalid/Missing Remark Code/ Message Number: • 4: The procedure code is inconsistent with the modifier used or a required modifier is missing• MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information. Resolution •…