Denial & Appeals Assistant · demo
Denied claims
Remittance
835 · remit 2026-10-24- Member
- Synthetic M-30577, 63 M, Medicare Advantage PPO (sample)
- Provider
- Northgate Orthopedics, Orthopedic surgery
- Service date
- 2026-10-06
- Claim no.
- 26279-018832
| Ln | Code | Billed | Paid | Denial |
|---|---|---|---|---|
| 1 | 20610-RT Arthrocentesis, major joint | $142.00 | $118.20 | Paid |
| 2 | 99214 Office visit, established, moderate | $168.00 | $0.00 | CO-97M15 |
| 3 | J3301 ×4 Triamcinolone acetonide, per 10 mg | $12.00 | $9.60 | Paid |
- CO-97 Contractual obligation: the provider can't bill the member for this amount. Payment for this service is included in the payment for another service on the same day.
- M15 Separately billed services were bundled as parts of the same procedure; separate payment is not allowed.
Office visit note
office-1 · 2026-10-06Patient: Thomas Reed DOB: 05/27/1963 MRN: 00418806 Callback: 555-904-3371 Chief complaints: 1. Right knee pain and swelling for 3 weeks. 2. Follow-up of type 2 diabetes. Reports home glucose readings of 180 to 220. Exam: Right knee effusion, medial joint-line tenderness, range of motion 5 to 110 degrees. Feet: monofilament sensation intact bilaterally. Assessment and plan: 1. Right knee osteoarthritis with effusion. Arthrocentesis with corticosteroid injection performed today (see procedure note). 2. Type 2 diabetes with hyperglycemia, not at goal. A1c ordered. Metformin increased to 1000 mg twice daily. Diabetic foot exam completed. Follow-up in 3 months.
Procedure note
proc-1 · 2026-10-06Procedure: Right knee arthrocentesis with injection. Indication: Symptomatic effusion with osteoarthritis. Consent obtained. Aspirated 30 mL clear yellow fluid. Injected triamcinolone acetonide 40 mg with lidocaine. Tolerated well, no complications.
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