01/30/2019

Wellcare Denial for 99212 with DX G57.61 & G57.62

We billed WellCare a 99212 with diagnosis G57.61 and G57.62. Wellcare is denying with IH147-Inconsistent ICD-10/Modifier or Mutually Exclusive diagnosis. Help!

The denial from Wellcare can be resolved in one of two ways:

• If this patient had a surgical procedure or injection within 90 days from the DOS, the office visit should be resubmitted to Wellcare with Modifier 24 to show that the encounter for the treatment of Mortons neuroma was not related to the global period of another procedure

• If the patient did not have a surgery or injection prior to the DOS and the encounter was only an evaluation, an appeal should be sent to Wellcare since:
• No modifiers are required for an E&M code if it is the only service billed on the DOS
• ICD-10 codes G57.61 & G57.62 are specific codes that denote laterality that are billed