Medicare Denials

November 1, 2008

Medicare seems to be denying 93000 (EKG) more than usual. Should I be using a modifier? The denial code is 16: Claim service lacks information, which is needed for adjudication.

Question: Medicare seems to be denying 93000 (EKG) more than usual. Should I be using a modifier? The denial code is 16: Claim service lacks information, which is needed for adjudication.

Answer: Given the denial code, I don’t think coding is at issue. But apparently, there is some information that is missing on the claim. Look for a remark code on the far left side of the paper remittance. This will advise you about what is missing or incomplete.