Medical Codes for Chronic Lung Disease [Infographic]

Medical Codes for Chronic Lung Disease [Infographic]

Some of the common chronic lung conditions that can adversely affect the quality of one’s life are Chronic Obstructive Pulmonary Disease or COPD (Emphysema and chronic bronchitis), asthma, cystic fibrosis, and occupational lung diseases. These diseases can affect the lungs and other parts of the respiratory system. Pulmonologists, respiratory therapists, primary care providers or other specialists involved in treating lung conditions can consider the support of an experienced medical coding company to report their services accurately on the medical claims and thus get proper reimbursement from insurers.

Proper diagnosis of Chronic lung disease (CLD) may involve a chest X-ray that shows scar tissues in the lungs, blood tests, Electrocardiogram (ECG), Echocardiogram, Computerized tomography (CT), Magnetic resonance imaging (MRI), Open-lung biopsy, Lung (pulmonary) function test, or even Sleep study (polysomnogram).  Pulmonary medical coding involves assigning accurate diagnosis and procedure codes for the treated conditions on physicians’ medical claims.

Medical Codes for Chronic Lung Disease

Coding Skin Disorders Using ICD-10 Medical Codes

Coding Skin Disorders Using ICD-10 Medical Codes

Dermatologists treat a wide variety of skin complex conditions. There are many challenges associated with reporting diagnoses such as the specificity and granularity of ICD-10 codes. Relying on a medical coding company that specializes in dermatology medical billing and coding can ensure error-free, timely claim submission. 

Let’s take a look at the ICD-10 codes for 7 common skin conditions

ICD-10 Codes for Common Skin disorders

  • Acne 

Acne is a most common skin disease in the United States. It usually begins during puberty and affects many adolescents and young adults. According to American Academy of Dermatology Association (AAD), almost 50 million people struggle with acne every year. Over-active sebaceous glands, abnormal shedding of dead skin cells, multiplication of acne causing bacteria are the reasons for acne. The ICD-10 codes for acne are as follows:

  • L70  Acne
  • L70.0  Acne vulgaris
  • L70.1  Acne conglobata
  • L70.2  Acne varioliformis
  • L70.3  Acne tropica
  • L70.4  Infantile acne
  • L70.5  Acné excoriée
  • L70.8  Other acne
  • L70.9  Acne, unspecified
  • Sunburn

Sunburn is a serious skin condition that can alter its behavior to cancer. According to certain reports, almost half of the population in America is under treatment for sunburn. Too much exposure to UV rays might damage the deeper cells of the skin and cause sunburn. ICD-10 codes for effective documentation for claim submission are as follows:

  • L55  Sunburn
  • L55.0  Sunburn of first degree
  • L55.1  Sunburn of second degree
  • L55.2  Sunburn of third degree
  • L55.9  Sunburn, unspecified
  • Atopic Dermatitis

One in 10 people in the U.S. develops atopic dermatitis during their lifetime. According to the AAD, this condition affects 25% of children and 3% of adults. It is also known as eczema. A combination of factors such as immune system activation, genetics, environmental condition, stress cause Atopic dermatitis. The ICD-10 codes for this condition include:

  • L20  Atopic dermatitis
  • L20.0  Besnier’s prurigo
  • L20.8  Other atopic dermatitis
  • L20.81  Atopic neurodermatitis
  • L20.82  Flexural eczema
  • L20.83  Infantile (acute) (chronic) eczema
  • L20.84  Intrinsic (allergic) eczema
  • L20.89  Other atopic dermatitis
  • L20.9  Atopic dermatitis, unspecified
  • Rosacea

In the U.S., rosacea is a common skin condition among citizens. According to AAD, almost 16 million people are under treatment for this skin condition. This medical condition can develop irrespective of age, gender and race. The specific group of people who falls under the risk category of rosacea is:

  • People of age group between 30 and 60
  • Individuals who are fair and have blond hair and blue eyes.
  • Women who are at the stage of menopause
  • Those having a family history of rosacea

Although the causes of rosacea are unclear, it is assumed that an overactive immune system and hereditary and environmental factors are responsible for the condition. The ICD-10 codes for rosacea are:

  • L71  Rosacea
  • L71.0  Perioral dermatitis
  • L71.1  Rhinophyma
  • L71.8  Other rosacea
  • L71.9  Rosacea, unspecified
  • Shingles

Shingles or herpez zoster is a skin condition that affects 1 in 3 people in the U.S. (CDC). Though most people are affected only once in their lifetime, there is a risk of the condition recurring. Older adults are in the high risk category as they have a weakened immune system. The condition is caused by varicella-zoster virus. The ICD-10 codes for shingles are as follows:

  • B02  Zoster [herpes zoster]
  • B02.0  Zoster encephalitis
  • B02.1  Zoster meningitis
  • B02.2  Zoster with other nervous system involvement
  • B02.21  Postherpetic geniculate ganglionitis
  • B02.22  Postherpetic trigeminal neuralgia
  • B02.23  Postherpetic polyneuropathy
  • B02.24  Postherpetic myelitis
  • B02.29  Other postherpetic nervous system involvement
  • B02.3  Zoster ocular disease
  • B02.30  …… unspecified
  • B02.31  Zoster conjunctivitis
  • B02.32  Zoster iridocyclitis
  • B02.33  Zoster keratitis
  • B02.34  Zoster scleritis
  • B02.39  Other herpes zoster eye disease
  • B02.7  Disseminated zoster
  • B02.8  Zoster with other complications
  • B02.9  Zoster without complications
  • Athlete’s Foot 

Athlete’s foot or tinea pedis is a common condition caused by a fungus called dermatophytes. According to National Center for Biotechnology Information (NCBI), almost 3% to 15% of the U.S. population has an athlete’s foot. Estimates also suggest that 70% of the population will get athlete’s foot at some point in their lifetime. The ICD-10 code for athlete’s foot is:

  • B35.3  Tinea pedis
  • Basal Cell Carcinoma

Basal cell carcinoma is a common type of skin cancer caused by the mutation of DNA in basal cells. According to the American Cancer Society, every year, about 5.4 million people are diagnosed with basal cell carcinoma. The ICD-10 codes for Basal Cells Carcinoma are as follows:

  • C44.01  Basal cell carcinoma of skin of lip
  • C44.11  Basal cell carcinoma of skin of eyelid, including canthus
  • C44.111  Basal cell carcinoma of skin of unspecified eyelid, including canthus
  • C44.112  Basal cell carcinoma of skin of right eyelid, including canthus
  • C44.1121  Basal cell carcinoma of skin of right upper eyelid, including canthus
  • C44.1122  Basal cell carcinoma of skin of right lower eyelid, including canthus
  • C44.119  Basal cell carcinoma of skin of left eyelid, including canthus
  • C44.1191  Basal cell carcinoma of skin of left upper eyelid, including canthus
  • C44.1192  Basal cell carcinoma of skin of left lower eyelid, including canthus
  • C44.21  Basal cell carcinoma of skin of ear and external auricular canal
  • C44.211  Basal cell carcinoma of skin of unspecified ear and external auricular canal
  • C44.212  Basal cell carcinoma of skin of right ear and external auricular canal
  • C44.219  Basal cell carcinoma of skin of left ear and external auricular canal
  • C44.31  Basal cell carcinoma of skin of other and unspecified parts of the face
  • C44.310  Basal cell carcinoma of skin of unspecified parts of the face
  • C44.311  Basal cell carcinoma of skin of the nose
  • C44.319  Basal cell carcinoma of skin of other parts of the face
  • C44.41  Basal cell carcinoma of skin of the scalp and ne
  • C44.51  Basal cell carcinoma of skin of the trunk
  • C44.510  Basal cell carcinoma of anal skin
  • C44.511  Basal cell carcinoma of skin of the breast
  • C44.519  Basal cell carcinoma of skin of other parts of the trunk
  • C44.61  Basal cell carcinoma of skin of upper limb, including shoulder
  • C44.611  Basal cell carcinoma of skin of unspecified upper limb, including shoulder
  • C44.612  Basal cell carcinoma of skin of right upper limb, including shoulder
  • C44.619  Basal cell carcinoma of skin of left upper limb, including shoulder
  • C44.71  Basal cell carcinoma of skin of lower limb, including hip
  • C44.711  Basal cell carcinoma of skin of unspecified lower limb, including hip
  • C44.712 Basal cell carcinoma of skin of right lower limb, including hip
  • C44.719  Basal cell carcinoma of skin of left lower limb, including hip
  • C44.81 Basal cell carcinoma of overlapping sites of skin
  • C44.91 Basal cell carcinoma of the skin, unspecified

There are many skin conditions and each has its own ICD-10 codes and sub-codes and coders need to be vigilant when helping physicians report them on claims. On their part, dermatologists need to ensure proper documentation of the various conditions they treat. The important records required to meet the needs of claim submission include:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report 

Source: CMS.gov 

Medical billing outsourcing companies that provide dermatology medical billing services have expert certified coding teams that stay up to speed with ICD-10 coding to help physicians file error-free claims for accurate and timely reimbursement.

The medical coders enter codes based on the medical report prepared by the physician. Thus, for filing perfect reimbursement, a joint effort between physicians and medical coders are necessary. Thus, physicians should enter the medical condition accurately. ICD-10 codes are necessary for effective claim submission. 

Proper, adequate coding and documentation has become an increasingly important aspect of modern medicine, especially with the prevalence of electronic health records (EHR). While electronic records provide some documentation benefits to the physician, such as legibility and ease of inter-physician communication, they also carry potential coding risks. Many EHR systems automatically calculate the level of service and procedure codes based on physician documentation. This can be convenient but carries the risk of coding incorrectly and potentially reduces the incentive to learn the nuances of coding. Regardless of the coding generated by the EHR or billing staff, the physician is ultimately responsible. 

How Does A Medical Billing Outsourcing Company Code Vertigo And Its Treatments?

How Does A Medical Billing Outsourcing Company Code Vertigo And Its Treatments?

Vertigo is a sensation of feeling off balance that often comes with symptoms such as vomiting, headache, sweating, spinning, going unbalanced, or pulled to one direction. Even though the main cause of the condition is related to issues with the inner ear balance, it can also be triggered by certain head movements or benign paroxysmal positional vertigo (BPPV), migraines, inner ear infection (labyrinthitis) or inflammation of the vestibular nerve (vestibular neuronitis). Otolaryngologists and neurologists can ensure accurate medical coding for vertigo on their medical claims with the support of an experienced medical coding company.

ICD-10 Codes to Indicate a Diagnosis of Vertigo

  • A88.1 Epidemic vertigo
  • H81.10 Benign paroxysmal vertigo unspecified ear
  • H81.11 Benign paroxysmal vertigo right ear
  • H81.12 Benign paroxysmal vertigo left ear
  • H81.13 Benign paroxysmal vertigo bilateral
  • H81.20 Vestibular neuritis unspecified ear
  • H81.21 Vestibular neuronitis right ear
  • H81.22 Vestibular neuronitis left ear
  • H81.23 Vestibular neuritis bilateral
  • H81.31 Aural vertigo
    • H81.311 Other peripheral vertigo right ear
    • H81.312 Other peripheral vertigo left ear
    • H81.313 Other peripheral vertigo bilateral
    • H81.319 Other peripheral vertigo unspecified ear
    • H81.391 Other peripheral vertigo right ear
    • H81.392 Other peripheral vertigo left ear
    • H81.393 Other peripheral vertigo bilateral
    • H81.399 Other peripheral vertigo unspecified ear
  • H81.4 Vertigo of central origin
  • H81.8 Other disorders of vestibular function
    • H81.8X Other disorders of vestibular function
    • H81.8X1 …… right ear
    • H81.8X2 …… left ear
    • H81.8X3 …… bilateral
    • H81.8X9 …… unspecified ear
    • H81.91 Unspecified disorder of vestibular function, right ear
    • H81.92 Unspecified disorder of vestibular function, left ear
    • H81.93 Unspecified disorder of vestibular function, bilateral
  • R42 Dizziness and giddiness
    • T75.23XA Vertigo from infrasound initial encounter
    • T75.23XD Vertigo from infrasound subsequent encounter
    • T75.23XS Vertigo from infrasound sequela

    ICD-10 Codes to Indicate Diagnostic Studies for Vertigo

    Along with physical examination, other tests used to diagnose the condition include hearing tests done by an ENT specialist such as audiometry test, tuning fork test, videonystagmography, caloric testing, dynamic or static platform posturography, and CT or MRI scan of head.

    • Z01.1 Encounter for examination of ears and hearing
      • Z01.10 …… without abnormal findings
      • Z01.11 Encounter for examination of ears and hearing with abnormal findings
      • Z01.110 Encounter for hearing examination following failed hearing screening
      • Z01.118 Encounter for examination of ears and hearing with other abnormal findings
      • Z01.12 Encounter for hearing conservation and treatment
    • R94.12 Abnormal results of function studies of ear and other special senses
      • R94.120 Abnormal auditory function study
      • R94.121 Abnormal vestibular function study
      • R94.128 Abnormal results of other function studies of ear and other special senses

    CPT Procedure Codes

    • 92517 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP)
    • 92518 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP)
    • 92519 Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP)
    • 92537 Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool irrigation in each ear for a total of four irrigations)
    • 92538 Caloric vestibular test with recording, bilateral; monothermal (i.e., one irrigation in each ear for a total of two irrigations)
    • 92540 Basic vestibular evaluation, includes spontaneous nystagmus test with eccentric gaze fixation nystagmus, with recording, positional nystagmus test, minimum of 4 positions, with recording, optokinetic nystagmus test, bidirectional foveal and peripheral stimulation, with recording, and oscillating tracking test, with recording
    • 92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
    • 92542 Positional nystagmus test, minimum of 4 positions, with recording
    • 92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording
    • 92545 Oscillating tracking test, with recording
    • 92546 Sinusoidal vertical axis rotational testing
    • 92547 Use of vertical electrodes (list separately in addition to code for primary procedure)
    • 92548 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report
    • 92549 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (i.e., eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT)
    • 92552 Pure tone audiometry (threshold); air only
    • 92553 Pure tone audiometry (threshold); air and bone
    • 92556 Speech audiometry threshold; with speech recognition
    • 92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)

    Some of the effective treatments recommended to treat vertigo symptoms include Epley maneuver, and vestibular rehabilitation training (VRT). Medications such as prochlorperazine and certain antihistamines may be recommended in the early stages of vertigo. In rare cases, surgery may be needed.

    ENT specialists, neurologists and other specialists treating vertigo conditions can consider hiring professional medical coding services to ensure accurate medical coding and prevent claim denials.

Special ICD-10 Codes To Keep Handy While Celebrating New Year

Special ICD-10 Codes To Keep Handy While Celebrating New Year

When festivities reach their zenith, it is obvious that healthcare professionals have to deal with unusual patient health conditions. New Year is round the corner and excitement is in the air as people have started gearing up for family get-togethers and preparing delicacies. But partying with friends and families poses the risk of food-poisoning and alcohol overuse. Watching fireworks has the risk of not only burn injuries but also respiratory issues arising out of air-pollution. Dancing to the beat is part of the celebration but people barely realize that strenuous and repetitive movements can cause overexertion. Besides, there are chances that late night drives can increase the risk of road accidents.

A medical coding company knows how important patient care is when such emergency situations happen. Physicians are kept busy attending to injured patients and providing the right treatment and care. They cannot however, ignore proper documentation of the diagnoses and treatment, which is imperative for appropriate medical reimbursement. So, relying on medical billing and coding services is vital for busy health practitioners.

ICD 10 Codes for New Year-related Health Conditions

ICD-10 Codes for Food-borne Intoxication

  • A05: Other bacterial foodborne intoxications, not elsewhere classified
    • A05.0: Foodborne staphylococcal intoxication
    • A05.1: Botulism food poisoning
    • A05.2: Foodborne Clostridrium perfringens [Clostridium welchii] intoxication
    • A05.3 : Foodborne Vibrio parahaemolyticus intoxication
    • A05.4: Foodborne Bacillus cereus intoxication.
    • A05.5: Foodborne Vibrio vulnificus intoxication
    • AO5.8: Other specified bacterial foodborne intoxications.

Amid the thrill of dining with loving family members there are chances that the food might be improperly preserved. The diagnosis of the condition requires detailed analysis of the patient history, symptoms, and the duration of the uneasiness. The doctors will direct the patient to undergo blood tests and stool culture to examine the presence of parasites for confirming the underlying cause. A detailed physical examination of the patient is also required.

ICD-10 Codes for Over–consumption of Alcohol

  • F10.99: Alcohol use, unspecified with unspecified alcohol-induced disorder

To make the party lively, the binge-drinker might get inebriated. Headache (R51), confusion and dehydration are some of the symptoms associated with excessive consumption of alcohol. The treatment strategy requires detoxification of the patient. Blood tests have to be performed to find the alcohol level in blood. Doctors have to evaluate whether medication is necessary or not.

ICD-10 Codes for Burn Injuries Due to Fireworks

Fireworks are a visual treat but even a slight negligence can cause harm. Sometimes, burn injuries can be fatal and medical practitioners have to care for the patients round-the clock. The initial step regarding the treatment of burn injuries is to provide first-aid. The severity of the burn is analyzed by assessing the wound. The treatment will be mainly focused on controlling the pain, removing dead tissues, and reducing infection.

Assigning appropriate medical codes seems complex, but a medical coding company can assist you in this process and ensure timely reimbursement.

  • T30: Burn and corrosion, body region unspecified
    • T30.0: Burn of unspecified body region, unspecified degree.
    • T30.4: Corrosion of unspecified body region, unspecified degree.
  • T31: Burns classified according to extent of body surface involved.
    • T31.0: Burns involving less than 10%of body surface.
  • T31.1: Burns involving 10-19% of body surface.
    • T31.10: Burns involving 10-19% of body surface with 0% to 9% third degree burns.
    • T31.11: Burns involving 10-19% of body surface with 10-19% third degree burns.
  • T31.2: Burns involving 20-29% of body surface.
    • T31.20: Burns involving 20-29% of body surface with 0% to 9% third degree burns.
    • T31.21: Burns involving 20-29% of body surface with 10-19% third degree burns.
    • T31.22: Burns involving 20-29% of body surface with 20-29% third degree burns.
  • T31.3: Burns involving 30-39% of body surface.
    • T31.30: Burns involving 30-39% of body surface with 0% to 9% third degree burns
    • T31.31: Burns involving 30-39% of body surface with 10-19% third degree burns.
    • T31.32: Burns involving 30-39% of body surface with 20-29% third degree burns.
    • T31.33: Burns involving 30-39% of body surface with 30-39% third degree burns.

ICD-10 Codes for Air-pollution Induced Respiratory Diseases Due to Fireworks

J60-J70: Lung diseases due to external agents.

  • J61: Pneumoconiosis due to asbestos and other mineral fibers.
  • J62: Pneumoconiosis due to dust containing silica.
    • JJ62.0: Pneumoconiosis due to talc dust.
    • J62.8: Pneumoconiosis due to other dust containing silica.
  • J63: Pneumoconiosis due to other inorganic substances.
    • J63.0: Aluminosis(of lung)
    • J63.1:Bauxite Fibrosis( of lung)
    • J63.2:Berylliosis
    • J63.3:Graphite Fibrosis( of lung)
    • J63.4: Siderosis
    • J63.5: Stannosis
    • J63.6: Pneumoconiosis due to other specified inorganic dusts.
  • J64: Unspecified Pneumoconiosis
  • J66: Airway disease due to specific organic dust.
    • J66.0: Byssinosis
    • J66.1: Flax-dresser’s disease
    • J66.2: Cannabinosis
    • J66.8: Airway disease due to other specific organic dust.
  • J67: Hypersensitivity pneumonitis due to organic dust.
    • J67.8: Hypersensitivity pneumonitis due to other organic dusts.
    • J67.9: Hypersensitivity pneumonitis due to unspecified organic dust.
  • J68: Respiratory conditions due to inhalation of chemicals, gases, fumes and vapors.
    • J68.0: Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors.
    • J68.1: Pulmonary edema due to chemicals, gases, fumes and vapors.
    • J68.2: Upper respiratory inflammation due to chemicals, gases, fumes and vapors, not elsewhere classifies.
    • J68.3: Other acute and subacute respiratory conditions due to chemicals, gases, fumes and vapors.
    • J68.4: Chronic respiratory conditions due to chemicals, gases, fumes and vapors.
    • J68.8: Other respiratory conditions due to chemicals, gases, fumes and vapors.
    • J68.9: Unspecified respiratory condition due to chemicals, gases, fumes and vapors.
  • J70: Respiratory conditions due to other external agents.
    • J70.5: Respiratory conditions due to smoke inhalation
    • J70.8: Respiratory conditions due to other specified external agents.
    • J70.9: Respiratory conditions due to unspecified external agent.

The doctor assesses the medical history of the patient with respiratory problems and enquires whether the patient has been exposed to lung irritants. Then the patient will be directed to take chest x-ray, lung (pulmonary) function tests, laboratory tests and CT scan. Typically, physicians advise patients with a previous history of breathing problem to be more cautious and stay away from fireworks.

ICD-10 Codes for Injury Due to Overexertion and Repetitive Movements

  • X50: Overexertion and strenuous or repetitive movements.
    • X50.1: Overexertion from prolonged static or awkward postures.
    • X50.3: Overexertion from repetitive movements.
    • X50.9: other and unspecified overexertion or strenuous movements or postures.

People will get high at the super-awesome New Year party with magical dance celebrations. There are chances that a bad sprain can spoil the entire mood of the party. Emergency consultation with the doctor will be required. The treatment offered will depend upon the degree of injury. They may need physical rehabilitation or even surgery.

ICD-10 Codes for Injury Due to Road Accidents

  • V89.2: Person injured in unspecified motor-vehicle accident, traffic.

Even though there are stringent rules in place to avoid road accidents on New Year Eve, still there are rising occurrences of mishaps due to driving under the influence of alcohol. Providing first-aid is the primary step taken to treat road accident victims. A detailed evaluation of the injury and its location is done. For example, if there is serious head injury, to stop bleeding, the patient has to undergo surgery.

Medical emergencies need immediate attention and stabilizing the patient is given prime importance by medical practitioners. A service-oriented medical coding company can ensure hassle-free coding for health conditions arising from a plethora of situations. Medical billing and coding services are essential to efficiently manage reimbursement of the claims and error-free documentation with the help of state-of-the-art technology.

When Is A Claim Submitted By A Medical Coding Company Denied As A Duplicate Service?

When Is A Claim Submitted By A Medical Coding Company Denied As A Duplicate Service?

Every practice deals with claim denials and ‘duplicate service’ is a common reason for denial. When a claim submitted by a medical coding company is denied as a duplicate service, it indicates that more than one claim was submitted for the same service, for the same patient, for the same date of service.

Blue Cross Blue Shield defines a duplicate claim as: “Any claim submitted by a physician or provider for the same service provided to a particular individual on a specified date of service that was included in a previously submitted claim”. This does not include corrected claims.

In most cases, the claim would have been already processed and paid or it is identical to a previously submitted claim. Practices need to strictly adhere to claim submission rules to avoid duplicate claims, which are not only counterproductive and costly, but can lead to scrutiny and integrity actions by the Medicare administrative contractor (MAC).

Reasons for Duplicate Claim/Service Denials

  • The service was performed more than once on the same day: The same provider may provide the same service for the same patient multiple times on the same day. The first claim is likely be processed and paid, and the second claim will be denied as a duplicate claim or service.

    Modifier 76 Repeat procedure or service by same physician or other qualified health care professional, should be appended to the second claim to indicate that the procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. Modifier 76 is used for surgeries, x-rays and injections. If the claim is denied again, you can appeal and provide documentation.

  • The same service was performed by another provider on the same date: A patient may receive a service on the same day with two different providers, A and B. If provider A submitted a claim with the same CPT code as provider B and received a payment prior to provider B’s claim, then provider B’s claim will get denied. In this case, the insurance company should be informed that provider B also performed the service and send the claim back for reprocessing. If the claim is not reprocessed, it can be appealed with supporting documentation.
  • Same service was performed bilaterally by one provider: Suppose the same provider performed the same procedure on both legs of the patient and both claims were submitted without the correct modifier, one claim may be paid and the other denied as a duplicate claim. Appending modifier 50 or RT and LT modifiers would indicate the same procedure performed bilaterally.
  • The service was performed once but billed twice: If the claim for a service is submitted twice, it will be denied as duplicate. This can occur inadvertently, but is a costly mistake. The payer will reimburse only the original claim and deny the second one. The practice’s medical billing service provider should ascertain whether the original claim has been processed for payment.
  • Submitting a corrected claim without proper information: It is important to file a corrected claim according to the payer’s specific instructions below to ensure that payer can identify the original claim, understand the correction that is required and ensure that the resubmitted claim is not denied as a duplicate. When a claim is corrected and resubmitted, it should be clearly indicated as a corrected claim along with the original claim ID, and reason for attachments or corrections. Claims that are submitted without the necessary information will be returned or denied as duplicates.

How to Respond to Duplicate Service Denials

  • If the claim for a service performed more than once on the same day is denied, verify if you submitted the claim with the appropriate modifier and other requirements. If not, rebill it with the correct modifier. On the other hand, if you submitted the claim correctly and it was still denied, submit a letter of appeal with documentation for each specific service to prove it was performed more than once and therefore is not a duplicate service.
  • For a claim that was submitted twice, a Find a Code article recommends verifying the following:
    • If the payment was made on the first claim, whether it was sent to the correct address?
    • If the check was deposited but missed in the posting process?
    • If payment was sent to the patient for failure to check the ‘accept assignment’ box on the HCFA form?
    • If the first claim submitted was denied and the denial was handled correctly. Sometimes claims can be resubmitted by simply correcting a diagnosis code, modifier, or other problem.
  • Denial due to ‘same service performed by another provider on the same date’ can be appealed using the method required by the insurance. Appeal methods differ among payers.

Partnering with an experienced provider of physician billing services can minimize claim denials and rejections and other billing errors. In the event that a claim is denied, they will follow up on it, and appeal claims that have not been processed correctly. Experts would also be familiar with the appeals and claim resubmission methods for each insurance company.