Tuesday, June 7, 2011

Avoiding X-ray or EKG - Duplicate denial - CPT 93010, 71010, 71020

Chest X-ray or EKG: Duplicate Denials – M80, CO15


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

Resolution/Resources


First: Verify the status of your claim before resubmitting. You can determine the status of a claim through the Online Provider Services (OPS) tool or by calling the Interactive Voice Response unit (IVR).



Online Claim Status Verification through OPS


  • All providers that have an EDI Enrollment Agreement on file may register to use this tool. If you haven’t already registered, please consider doing so.

  • Access the introductory article to learn more: Click on the 'Introducing Online Provider Services' graphic on the top of any of our main contract Web pages

  • One important consideration: Only one Provider Administrator per EDI Enrollment Agreement/per PTAN/NPI combination performs the registration process. The Provider Administrator can then grant permission to additional users related to that PTAN/NPI.

  • Billing services and clearinghouses should contact their provider clients to gain access to the system

  • Specific instructions for accessing claim status information through OPS are available in the OPS User Manual.

  • 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.

  • On electronic claims use the documentation record to specify the exact times that each diagnostic service (e.g., chest x-ray, EKG, etc.) was done

  • On electronic claims use the documentation record to explain why more than one diagnostic service was done on the same date by the same provider

  • Attachments (e.g., signed radiology reports, signed EKG reports, etc.) for paper claims must identify the patient’s name, Health Insurance Claim number, date of service and other pertinent information (e.g., times):

  • Attachments must be a full page (8 ½ x 11)

  • On appeal signed medical records (e.g., radiology reports, EKG reports, etc.) may be sent as evidence to show why more than one diagnostic service was billed on the same date by same or similar providers from the same group

  • If you need to make a correction to a claim that was incorrectly denied as a duplicate, you may request a Telephone Reopening

  • Access specific instructions for documenting and submitting CPT modifier 76 through the Modifier Lookup

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