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Thank you for any assistance provided!
Annette Vesey, CPC-A
13132-59 Claim paid
11200 Charge denied
Shouldn’t both claims pay seeing that the 59 was added for the NCCI edit?
17311-79
17311-79-59 (BSC left mid-jawline and BSC left lateral jawline//2 separate dx codes)
17312
14301-79
14302-79
Should 2 units of 17311 be billed instead of separate line items? 14302 and 17312 are the only charges that paid. How can the add-on be paid and not the parent code? This is GA Medicare.
21235 billed with 14061. Graft pays, flap denied.
When I was hired at my current job at a hospital many, many years ago I was instructed not to append -59 to multiple counts of the pathology codes [eg. 88300-26 x2]. We have never had any issues…now our billing department is wanting the "X" modifiers appended to them.
My question:
Is it appropriate to code 88300-26-XU for the gross description of two separate specimen? Or any other surgical pathology code with multiple counts of the same code, gross was just an example?
Thanks
My example is for the following:
DOS 11/22/17 CPT codes 96374. 96375
DOS 11/23/17 CPT codes 96376
Can they bill the 96376 on a different DOS without the initial billed code on the same date??
There was one incision which was extended. The OP report states: "We started the procedure with transverse incision following the crease on the right thumb. We could then locate mass with a ganglion cyst as well as exostosis on the distal phalanx. C-arm evaluation was used during the whole time to check for appropriate removal of the exostosis. We could then see that proximal phalanx also had a bone prominence. The wound was then extended proximally and distally in a T-shaped fashion. Care was taken to identify and protect the sensory branch of the radial nerve that was running on the radial side of the wound. With the help of a rongeur, the bone prominence exostoma was removed from the proximal phalanx distal portion was well."
thank you.
When billing to the Palmeto / Medicare Mac, you can put up to 13 units on one line, with no modifier, and all units pay.
First Coast rejects the claim, stating there are billing submission errors. We have tried using modifier 91 and 59, but they only pay for one unit and deny the rest as a duplicate.
Any insight would be greatly appreciated.
Thank you.
When healthcare providers perform multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical procedures include pre-procedure, intra-procedure, and post-procedure work. When multiple procedures […]
The post Coding and Billing “Multiple Procedures” appeared first on AAPC Knowledge Center.
The physician wants to code the following procedure as 31571 only. But to me it seems he is missing multiple procedures.
Here’s the op:
A dedo laryngoscope was inserted and supraglottic jet ventillation was started. the base of the tongue pyriform sinuses, and post-cricoid space were examines and found to be normal. The laryngoscope was then suspended and the operating microscope was brougt into the field. Wet eyepatches were placed on the patient. The CO2 laser was used to make 4 radial incisions in the region of the stenosis. The 14 mm acclarent dilator was then inflated to 10atm pressure. The patient was then intubated by myself using a #5 ETT and ventilation was resumed. Kenalog was injected in the region of the stenosis and a biopsy was taken from the left stenotic region.
To me I see: 31571,31528 but I am unsure how to code for the use of the laser because a direct laryngoscope was used.
Any help would be great.