chiropractic code #98941 failing in Medisoft 20

wrchiro · Post by **wrchiro** » Wed Jul 31, 2019 11:18 am

When in Medisoft 20 Revenue Manager we’re using our standard chiropractic manipulation code of #98942 and receiving the following error message:

Activity: Claim Failed Edits
Ref: CCI #98941 is not payable as coded (National Correct Coding Initiatives Edit)

We've used code #98942 for 20 years without a problem? We're unsure if this is a Medisoft error or a problem at the clearinghouse (Optum) we use when sending? If anyone has heard of this same problem please post a response and contact us at [email protected].

Thanks in advance!

Dr. Erica Cwalina
Wheat Ridge, Co

Billing contact:
Michael Turnbull
Cell: 303-521-0896
Email: [email protected]

Post by **Gavin Walker** » Thu Aug 01, 2019 7:44 am

Hi Dr. Cwalina, it says it is not payable as coded. What modifier code(s) are you using?

wrchiro · Post by **wrchiro** » Thu Aug 01, 2019 11:23 am

Hi Gavin,

it's Mike & Jill (billing) at Dr. C's office... we haven't used a modifier on this code for 20 years. we've been successful getting the billing to Optum/ENS in the past so this is confusing since nothing (we know of) has changed? Jill and I are in billing and she's the person that enters the coding.. may I please have her call you today to get your opinion, i'll spot her at the front desk so she isn't distracted and can take notes.

thanks in advance,
Michael and Jill

Dr. Erica Cwalina / Billing

wrchiro · Post by **wrchiro** » Thu Aug 01, 2019 2:29 pm

Hi Gavin,

in one email I errantly wrote 942... that's incorrect, it's the 98941 billing code. no modifiers ever attached to it!

Mike and Jill

Post by **Gavin Walker** » Fri Aug 02, 2019 7:56 am

Who is the insurance carrier and are they Medicare?

wrchiro · Post by **wrchiro** » Fri Aug 02, 2019 8:58 am

it was not Medicare... it's an array of insurance carriers. American Specialty, ASHN, Co Blue Shield, UMR to name a few... there didn't seem to be any pattern or connection between patients. some patients go thru to ENS without a problem, and others are fed flagged in Medisoft before we try to send them? I've taken screen shots of this if it would help you to see them?
Mike T.

wrchiro · Post by **wrchiro** » Tue Aug 06, 2019 3:11 pm

Hi Gavin,

I didn't see a response to my posting a week ago? did my last email make sense, it wasn't medicare and there's nothing linking the failed billing that I can see?

thanks,
Mike T.

Post by **Gavin Walker** » Tue Aug 06, 2019 10:08 pm

So this message is coming up from the CCI edits. These edits are designed for Medicare and you could get false positives for other insurance who either don't check for the modifier or don't care. I made this video where I show how to turn off unwanted edits. https://www.youtube.com/watch?v=vxum04DMVBQ&t=6s

wrchiro · Post by **wrchiro** » Tue Aug 13, 2019 1:10 pm

Gavin,

Thank you. We have been able to send all of our claims after this simple fix. We appreciate you so very much!

Mike and Jill

wrchiro · Post by **wrchiro** » Thu Aug 15, 2019 11:17 am

Hi Gavin,

Tuesday was a joyous day at our office. Thanks to your short vid which immediately fixed the problem, and are now back to business as usual. We're unsure how those modifiers could get turned, but now are aware of them and where to go IF this problem happened again. Thank you again!

Mike T.
Billing Dept. at Dr. Erica Cwalina's

chiropractic code #98941 failing in Medisoft 20

chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

we don't use a modifier on the manual manipulation code #98941

Re: chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

Re: chiropractic code #98941 failing in Medisoft 20

thanks for your short vid which immediately fixed our Medisoft problem

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