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  • Mutually Inclusive

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    Keesha Mash
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    The CPT code 99212 was denied as mutually inclusive with the primary code 66982 on the claim. Checking the NCCI edits showed a conflict between the codes but a modifier is allowed. The claim was submitted without a valid modifier. The representative suggested resubmitting the claim with a valid modifier. The corrected claim must be sent within 180 days to the address provided. The claim was sent to coding to add the appropriate modifier to code 99212.

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    The CPT code 99212 was denied as mutually inclusive with the primary code 66982 on the claim. Checking the NCCI edits showed a conflict between the codes but a modifier is allowed. The claim was submitted without a valid modifier. The representative suggested resubmitting the claim with a valid modifier. The corrected claim must be sent within 180 days to the address provided. The claim was sent to coding to add the appropriate modifier to code 99212.

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    67 views3 pages

    Mutually Inclusive

    Uploaded by

    Keesha Mash
    The CPT code 99212 was denied as mutually inclusive with the primary code 66982 on the claim. Checking the NCCI edits showed a conflict between the codes but a modifier is allowed. The claim was submitted without a valid modifier. The representative suggested resubmitting the claim with a valid modifier. The corrected claim must be sent within 180 days to the address provided. The claim was sent to coding to add the appropriate modifier to code 99212.

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    of 3

    claim denied as Mutually Inclusive

    Get the denial date and Which CPT is denied as inclusive


    Get the Major/primary CPT to which the CPT was considered as Inclusive?
    Verify in NCCI to verify whether it is truly inclusive or not ?

    When there is a conflict when There is no conflicts

    Is the claim already filed with valid modifier?


    Request to reprocess the claim
    F/UP date
    Yes No claim# & call-ref#

    Request to enquire with rep whether can send PC:


    reprocess the claim corrected claim with valid Mod or not ?
    Post notes and set f/up date
    F/UP date
    claim# & call-ref#

    PC: Yes No

    Post notes and set f/up date Collect the correct claim address or
    Fax# General update:
    Get the copy of EOB Move to coding team for any kind of coding
    claim# & call-ref# issues

    PC:
    Move to coding team to add Coding changed as the prior No Coding changed as the
    modifier coding was incorrect prior coding was correct
    Get the appeal limit
    Collect the appeal address or Fax#
    Get the copy of EOB Send the corrected claim with Send an appeal along with
    claim# & call-ref# coding changes medical records

    PC:
    Appeal the claim with MR
    1. Mat I have the denied CPT?
    2. May I know which Is primary / major CPT?
    3. I verified in NCCI and found there is no conflict between these
    codes, so could you pls send the clm back to review?
    4. I verified in NCCI/Find-a-code and found there is a conflict
    between these codes, and also we billed the claim along with
    valid modifier, so could you pls send the clm back to review?
    5. Is it possible to add valid modifier?
    6. May have the corrected claim TFL and address?
    7. May I have the appeal limit and address?
    Notes :

    Cld Aetna @ 800 251 4587 TT Mark sd the cpt 99212 got denied on
    03/01/2020 as mutually inclusive with the primary code 66982
    which is on the same clm. Chkd in NCCI edits found there is a
    conflict between these two codes and also modifier is allowed to
    bill with the denied code. Chkd in the system no modifier were
    added and also rep suggested to send the claim along with valid
    modifier. Corrected clm TFL 180 days from DOD. Address PO BOX
    7874 Dallas TX 75824. therefore sent the clm to coding dept to
    add the valid modifier for 99212. clm#71254 call-ref# 75421AB

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