Sunday, September 19, 2010

Chest X-ray or EKG: Duplicate Denials

Denial Reason, Reason/Remark Code(s)
  • M-80, CO-18 - Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate
  • CPT codes: 93010, 71010, 71020
First: Verify the status of your claim before resubmitting. You can determine the status of a claim by calling the Palmetto GBA Interactive Voice Response unit (IVR):

    • Jurisdiction 1: (866) 931-3903 begin_of_the_skype_highlighting              (866) 931-3903      end_of_the_skype_highlighting
    • Ohio and West Virginia: (877) 567-9232 begin_of_the_skype_highlighting              (877) 567-9232      end_of_the_skype_highlighting
    • South Carolina: (866) 238-9654 begin_of_the_skype_highlighting              (866) 238-9654      end_of_the_skype_highlighting
  • Submit multiple 'identical' services on the same claim. Use the quantity field to reflect the number of services. If the services cannot be submitted on a single claim, use CPT modifier 76 and specify the exact times of each service.
  • If you need to make a correction to a claim that was incorrectly denied as a duplicate, you may request a Telephone Reopening
    • Jurisdiction 1: (866) 669-5543 begin_of_the_skype_highlighting              (866) 669-5543      end_of_the_skype_highlighting. We can assist you with up to three requests per call.
    • Ohio and West Virginia: (866) 308-5441 begin_of_the_skype_highlighting              (866) 308-5441      end_of_the_skype_highlighting. We can assist you with up to three requests per call.
    • South Carolina: (866) 815-7891 begin_of_the_skype_highlighting              (866) 815-7891      end_of_the_skype_highlighting. We can assist you with up to three requests per call. 
  • Access specific instructions for documenting and submitting CPT modifier 76 through the Palmetto GBA Modifier Lookup:
    • Jurisdiction 1: Select 'Articles' on the left side of the Palmetto GBA Web page
    • Ohio, South Carolina, and West Virginia: Select 'Browse by Topic' on the left side of the Palmetto GBA Web page.

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