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Mar 19th, 2015 - ABQ894

Medicare denial for E/M service "qualifying service/procedure" not rendered...

Hi everyone,

I bill for a family practice/internist in NJ. Medicare is denying many of our E/M services (even when that is the only service rendered) for the denial code "CO-B15, M80 (THIS SERVICE\PROVIDER REQUIRES THAT A QUALIFYING SERVICE/PROCEDURE BE RECEIVED AND COVERED)"

Have any of you encountered this? If so, what on Earth would a qualifying service to an E/M code be! I mean a doppler or other test, sure, I can see the chain of decision making and coding there, but for an E/M code?

Thanks in advance!

Melissa

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Mar 19th, 2015 - LBAROGIANIS 250 

re: Medicare denial for E/M service

I am curious to know what E/M codes you are using.

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Mar 19th, 2015 - Kat31477 56 

re: Medicare denial for E/M service

A better question might be what diagnosis are you using? Often that type of denial is diagnosis driven. Did you contact the MAC for an explanation?

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Mar 19th, 2015 - phoover1955 7 

re: Medicare denial for E/M service

I agree w/Kat....your dx tells Mcare the medical necessity of the EM.

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