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What would be helpful is knowing which insurance plan these denials are coming from. Have you communicated with them and asked them why suddenly this happened?
More than likely this is a computer glitch. The reason, because the Medically Unncessary Edits (MUE) set a limit on how many units or times a HCPCS code can be billed on the same date. However, there are exceptions, such as for Left or Right. And since billing pairs of a HCPCS unit should not, according to HIPAA billing standards, be billed on the same line, you are submitting the claims correctly.
However, the exception the MUE may not have been encoded or may have been stripped out of the insurer's system. Hence the denials.
Again, to drill down more on this, one needs to know which carrier is doing this.
The other possibility is that you are billing an ICD10 with a unilateral code designation. Take the new ICD10 code for plantar fasciitis. If you bill only the ICD10 for left foot, then the left foot orthotic will be paid and the right will be denied. This is a coverage issue, and that is entirely another discussion with the carrier regarding the fact that they are now possibly creating an iatrogenic limb length discrepancy. Beyond that, ask them who gets covered these days for a monocle versus a pair of glasses?
As for the error codes, here is what I dug up from Noridian DME:
Reason Code: 4 — The procedure code is inconsistent with the modifier used.
Remark Code: N519 — Invalid combination of HCPCS modifiers.
If you were billing both codes on the same line, which you are not, then the N519 would be a possible error. But you are not. CO4 also seems to be the incorrect modifier.
My advice at this point will be to contact your PIAC representative in Texas. Regardless of whether you are an APMA member, the PIAC rep should be able to assist you with this, in particular if it is effecting all Texas orthotic providers. I will reach out to the Texas PIAC rep at the upcoming APMA CAC meeting to see how widespread an issue this is. Monitor this forum for updates.
I will also check with the orthotic laboratories I consult for to see if anyone else has identfied this as an issue.
—Paul Kesselman, DPM