Verified Error Examples
CPT Code Validation
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`01(10440)
8/16/2014
`10440
0
5
`164.0
$44,364.78
Cpt code 10440 is not a valid Cpt code Our system is updated continuously so that any deleted or non valid CPT codes are recognized and non payment would be recommended
`01(14270)
10/21/2013
`14270
0
3
`715.35
$3,424.80
Cpt code 14270 is not a valid Cpt code Our system is updated continuously so that any deleted or non valid CPT codes are recognized and non payment would be recommended
`01(51799)
8/20/2013
`51799
0
1
`600.01
Cpt code 51799 is not a valid Cpt code Our system is updated continuously so that any deleted or non valid CPT codes are recognized and non payment would be recommended
$112.64
`01(99361)
2/24/2014
`99361
1
`842.13
$26.04
Cpt code 99361 Not valid for fee schedule for Texas This code was deleted 01/01/2008 and per the Fee Schedule that Texas currently uses this claim line would be recommended for non payment
`01(00101)
2/28/2014
`00101
2
`786.09
Cpt code 00101 is not a valid Cpt code Our system is updated continuously so that any deleted or non valid CPT codes are recognized and non payment would be recommended
HCPCS Validation
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
`02(Z0750)
4/3/2014
`Z0750
0
1
`959.7
Z0750 is not a valid HCPCS code Our system is updated continuously so that any deleted or non valid CPT codes are recognized and non payment would be recommended
Diagnosis Code Validation
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
$144.29
Paid
$29.40
Paid
`03(1090)
9/10/2013
`86480
0
1
109.0
$54.93
Dx code 109.0 is not a valid Icd 9 code Our system is built to recognize valid and up to date ICD 9 codes and requires that the ICD 9 be reported with the appropriate set of digits required for that specific ICD 9 code `03(296)
4/22/2014
`90837
0
1
`296
$96.72
Dx code 296 requires a 5th digit Our system is built to recognize valid and up to date ICD 9 codes and requires that the ICD 9 be reported with the appropriate set of digits required for that specific ICD 9 code `03(9959)
12/23/2013
`87491
0
1
`995.9
$50.20
Dx code 995.9 requires a 5th digit
Our system is built to recognize valid and up to date ICD 9 codes and requires that the ICD 9 be reported with the appropriate set of digits required for that specific ICD 9 code `03(839.2)
6/26/2013
`97014
1
`839.2
$3.69
Dx code 839.2 requires a 5th digit
Our system is built to recognize valid and up to date ICD 9 codes and requires that the ICD 9 be reported with the appropriate set of digits required for that specific ICD 9 code `924.0
$395.00
`03(924.0)
1/21/2014
`99283
1
Our system is built to recognize valid and up to date ICD 9 codes and requires that the ICD 9 be reported with the appropriate set of digits required for that specific ICD 9 code Page 1 of 4
Service Verification & Medical Necessity
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`10(23515)
9/23/2013
`23515
0
1
`786.6
$1,800.00
Cpt coe 23515‐Open treatment of clavicular fracture, includes internal fixation, when performed
Icd 9 code 786.6‐Swelling, mass, or lump in chest
This claim line is for treatment of a clavicular fracture and the only diagnosis code attached to this claim line is for swelling, mass, or lump in the chest. Due to our systems extensive logic database we would recommend non‐ payment for failure to provide medical necessity for CPT code 23515
`10(46916)
8/22/2014
`46916
0
1
`781.1
Cpt code 46916‐Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery
Icd 9 code 781.1‐Disturbances of sensation of smell and taste
$200.00
Cpt code 46916 destruction of lesion ,anus has a billed diagnosis code of 781.1 disturbance of sensation of smell and taste. Due to the extensive logic built in to our database we would recommend non payment for failure to provide medical necessity for CPT code 46916
`10(56501)
11/20/2014
`56501
0
1
Cpt code 56501‐Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
Icd 9 code 781.1‐Disturbances of sensation of smell and taste
`10(64420)
2/24/2014
`64420
0
Cpt code 64420‐Injection, anesthetic agent; intercostal nerve, single
Icd 9 code 355.79‐Other mononeuritis of lower limb
1
`10(73030)
7/17/2014
`73030
0
1
Cpt code 73030‐Radiologic examination, shoulder; complete, minimum of 2 views
Icd 9 code 805.6‐Closed fracture of sacrum and coccyx without mention of spinal cord injury
`781.1
$110.54
`355.79
$96.26
`805.6
$62.10
`10(90656)
2/13/2014
`90656
0
1
`802.38
$54.80
Cpt code 90656‐Influenza virus vaccine,trivalent,split virus,preservative free,when administered to individuals 3 years and older for intramuscular use
Icd 9 code 802.38‐ Open fracture of other and unspecified part of body of mandible
`10(93000)
7/7/2014
`93000
0
1
Cpt code 93000‐Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
Icd 9 code 848.8‐Other specified sites of sprains and strains
`848.8
$54.40
`10(00100)
1/29/2014
`00100
0
1
Cpt code 00100‐Anesthesia for procedures on salivary glands, including biopsy
Icd 9 cdoe 844.9‐Sprain and Strain unspecified site of knee and leg
`844.9
$137.60
`10(29130)
5/4/2014
`29130
CPT code 29130‐Application of finger splint; static
Icd 9 code 922.1‐Contusion of chest wall
1
`922.1
$36.56
1
`924.11
$49.48
`10(73510)
9/16/2013
`73510
0
1
Cpt code 73510‐Radiologic examination, hip, unilateral; complete, minimum of 2 views
Icd 9 code 923‐Contusion of shoulder region
`923.00
$39.00
`10(93010)
8/27/2012
`93010
0
1
CPt code 93010‐Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
Icd 9 code730.01‐Acute osteomyelitis, shoulder region
`730.01
$12.94
`920
$628.12
0
`10(70140)
11/27/2012
`70140
0
Cpt code 70140‐Radiologic examination, facial bones; less than 3 views
Icd9 code924.11‐Contusion of knee
`10(00211)
5/4/2014
`00211
0
68
CPT code 00211‐Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma
Icd 9 code 920‐Contusion of face, scalp, and neck except eye(s)
`10(12002)
8/5/2014
`12002
0
1
`873.42
$239.41
Cpt code 12002‐Simple repair of superficial wounds of scalp,neck,axillae,external genitalia,trunk and/or extremities(including hands and feet);2.6 cm to 7.5 cm
Icd 9 code 873.42‐Open wound of forehead, without mention of complication
Page 2 of 4
`10(25600)
4/25/2014
`25600
0
1
`842.00, 923.21, 814.00
$717.02
Cpt code 25600‐Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation
Icd 9 code 923.21‐Contusion of wrist
Icd 9 code 842.00‐Sprain and strain of unspecified site of wrist
Icd9 code 814.00‐Unspecified closed fracture of carpal bone
`10(28055)
8/8/2014
`28055
Cpt code 28055‐Neurectomy, intrinsic musculature of foot
Icd 9 code 727.03‐Trigger finger (acquired)
Icd 9 code 272.4‐Other and unspecified hyperlipidemia
Icd 9 code 305‐Nondependent alcohol abuse, unspecified
Icd 9 code V15.82‐History of tobacco use
0
1
`727.03,272.4,305.00,V15.82
$1,136.50
`10(64415)
8/13/2014
`64415
Cpt code 64415‐Injection, anesthetic agent; brachial plexus, single
Icd 9 code 841.8‐Other specified sites of elbow and forearm
0
1
`841.8
$91.60
`10(70030)
8/14/2014
`70030
0
1
Cpt code 700.30‐Radiologic examination, eye, for detection of foreign body
Icd 9 code 840.9‐Sprain and strain of unspecified site of shoulder and upper arm
`840.9
$40.34
`10(90715)
7/23/2014
`90715
0
1
`913.1
Cpt code 90715‐Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
Icd 9 code 913.1‐Abrasion or friction burn, infected
(P) NCCI – Rejected service is part of another service
Remark
DOS
CPT
$40.01
Mods
Units
Diagnosis Codes
Paid
`111(29881‐,‐,)
5/2/2014
Cpt codes 29875 and 29881 have an NCCI edit `29875
0
1
`717.49
$1,940.30
`111(01740‐,‐,)
12/8/2013
Cpt codes 64415 and 01740 have an NCCI edit `64415
0
1
`812.40
$213.74
`111(10060‐,‐,)
6/5/2014
Cpt codes 10060 and 96372 have an NCCI edit `96372
0
1
`682.2
$38.11
`111(26605‐,‐,)
3/24/2014
Cpt codes 26605 and 29075 have an NCCI edit `29075
0
1
`719.42,841.9,719.44,815.00
$60.23
(P) NCCI – Rejected service is part of another service
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`116(96360‐,‐,)
6/6/2014
Cpt codes 96360 and 96372 have an NCCI edit `96372
0
1
`614.9
$380.80
`116(96374‐,‐,)
2/9/2014
Cpt codes 96374 and 36000 have an NCCI edit `36000
0
1
`466.0,787.01,787.91
$419.40
(P) NCCI – Rejected service is part of another service
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`117(99203‐,‐,)
6/2/2014
Cpt codes 99203 and 99202 have an NCCI edit `99202
0
1
`535.00
$117.31
`117(99219‐,‐,)
1/18/2014
Cpt codes 99285 and 99219 have an NCCI edit `99285
0
1
`786.59,401.0,584.9,784.0
$4,153.13
(F) NCCI – Rejected service is part of another service
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`120(29874‐59,‐59,)
4/17/2014
`29881
59
Cpt codes 29874 and 29881 have an NCCI edit; modifier not allowed 1
`715.16,717.2,717.6
$2,601.00
`120(64493‐59,LT,‐59,)
1/16/2014
`63047
59
Cpt codes 64493 and 63047 have an NCCI edit; modifier not allowed 1
`722.10,722.52,724.02,721.3
$704.35
Page 3 of 4
(P) NCCI – Rejected service is part of another service
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
7
`250.13,276.51
$33.86
`131(87184‐26,‐26,)
9/22/2013
`87185
26
1
Cpt codes 87184 and 87185 have an NCCI edit; mutually exclusive procedures `820.21,348.30,584.9,276.1
$12.47
`131(82947‐26,‐26,)
8/28/2014
`82962
26
Cpt codes 82962 and 82947 have an NCCI edit; mutually exclusive procedures
Units Validation
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
Paid
`20(64415)
1/14/2013
Mue edit for CPT code 64415 max units 2 `64415
0
4
`726.0
$960.00
`20(27248)
5/10/2013
MUE edit for Cpt code 27248 max units 1
`27248
0
5
`401.9
$11,580.57
`20(64520)
5/27/2014
MUE edit for Cpt code 64520 max units 1
`64520
0
3
`455.9
$59.39
CPT
Mods
Units
Diagnosis Codes
Paid
`99381 12/1/1984
1
779.31
$330.30
Age Restriction Verification for Cpt Codes Remark
DOS
`50(30YU)
2/18/2014
99381‐Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient;infant (age younger than 1 year)
This CPT code has an age contigency that could likely pass through undetected if the system orginally being used does not have an edit set in place
`50(1YL)
10/3/2014
`99383 9/17/2013
1
`V20.2
$82.93
99383‐Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination,counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years)
This CPT code has an age contigency that could likely pass through undetected if the system orginally being used does not have an edit set in place
Diagnosis codes reported insufficient for processing
Remark
DOS
CPT
Mods
Units
Diagnosis Codes
`90(E8490)
10/6/2014
`80048
0
1
`E849.0
Primary dx code E8490‐Place of occurrence, home*"E" code classification should be used as an additional code for more detailed analysis
`90(E906.0)
4/8/2014
`99203
1
The "E" code classification should be used as an additional code for more detailed analysis.
Paid
$5.00
`E906.0
$112.85
Diagnosis Codes
Paid
`599.72
$5,486.75
Diagnosis Codes
Paid
`92(46255‐80,,,)
2/1/2014
`46255
80
1
`455.7
Cpt code 46255‐Hemorrhoidectomy, internal and external, single column/group; *Modifier 80 is unacceptable for this procedure
$2,246.19
Inappropriate use of modifier
Remark
DOS
CPT
Mods
Units
`91(52005‐50,,,)
5/15/2014
`52005
50
1
Cpt code 46346‐Injection of sclerosing solution, hemorrhoids *Modifier 50 is unacceptable for this procedure
Modifier to Service Validation
Remark
DOS
CPT
Mods
Units
Page 4 of 4