Saturday, August 13, 2016

Global surgery denial code B15, CO 97, B20 AND MA130

Remittance Record

“Claim/service denied/reduced because this procedure/service is not paid separately.” (Reason Code B15. Group code CO 97)

2. Messages for Global Packages Split Between Two or More Physicians

When a physician furnishes only the pre- and intra-operative services, but bills for the entire package, the following statements on the MSN and remittance advice.

 “Payment has been reduced because a different doctor took care of you before and/or after the surgery. You should not be billed for this item or service. You do not have to pay this amount.”

“Charges denied/reduced because procedure/service was partially or fully furnished by another physician.” (Reason Code B20, Group Code CO B20)

3. Message for Procedure Codes With “ZZZ” Global Period Billed as Stand-Alone Procedures

When a physician bills for a surgery with a “ZZZ” global period without billing for another service, include one of the following statements on the MSN and remittance notice.
A/B MACs (B) include the following message on the MSN for claims:

This item or service was denied because information required to make payment was missing.” (CO 16)

 “Please ask your provider to submit a new, complete claim to us.”

(NOTE: Add on to other messages as appropriate).

16. When using 16, A/B MACs (B) should also use a claim remark code such as a return/reject code (MA 29MA 43, etc.) to show why claim rejected as incomplete.

Message for Payment Amount When Modifier “-22” Is Submitted Without Documentation

When a physician submits a claim with modifier “-22” but does not provide additional documentation, use the following or a similar remittance advice message:

9.7 - “We have asked your provider to resubmit the claim with the missing or correct information.” (NOTE: Add on to other messages as appropriate.) MA 130

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