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   RE: Coding help
 From: Marie Amina Aryan, NP-C
 To: Member Forum
 Posted: 12-19-2017 19:24
 Message: Hello all,

Any issues with Tricare and vaccine reimbursement? Medicare primary, Tricare secondary for a Tdap I administered. The allowed charge was $32 for the vaccine (not administration)-about $17 less than what I paid for the vaccine.
Thanks,

Marie

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Marie Amina Aryan, NP-C
FNP
Lakewood Family Health Clinic
303-578-8191
Lakewood, Colorado
Empathetic Family Healthcare clinic
Lakewood CO
303-981-1902Empathetic Family Healthcare clinicEmpathetic Family Healthcare clinicEmpathetic Family Healthcare clinic
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Original Message:
Sent: 11-18-2017 13:23
From: Mamatha Agrawal
Subject: Coding help

This Medicare claim keeps getting rejected.
I did a visit, pre-op EKG and a biopsy on the face which turned out to be basal cell on the pathology.

The visit is 99214-25 (E11.65 uncontrolled diabetes, M48.061 lumbar spinal stenosis)
11311 (procedure on face and coded as C44.319 basal call on face) I tried this without modifier 51 and then added modifier 51.
93000 EKG (tried coding as pre-op exam, then as abnormal EKG)

Any thoughts? I don't mind just sacrificing the pre-op EKG. Does the mole have to be coded nevus uncertain nature?
Generally do they pay for EKGs that are just for pre-op for Medicare patients?

The rejection note said " PER CCI GUIDELINES PROCEDURE CODE 93000 HAS AN UNBUNDLE RELATIONSHIP WITH PROCEDURE CODE 11311 BILLED FOR THE SAME DATE OF SERVICE. REVIEW DOCUMENTATION TO DETERMINE IF A MODIFIER OVERRIDE IS APPROPRIATE."

THANKS!

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Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
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