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67028 and 65800

Brenda Posted Thu 24th of March, 2016 17:13:13 PM

My doctor has been doing CPT 65800, Paracentesis with an Avastin injection. We are receiving denials for 67028 when we bill with 65800. They pay the 65800 but deny the 67028 with adjustment code CO236. We put a modifier 59 with the 65800. These two codes are not mutually exclusive according to the cci edits. I would appreciate any information on how to bill these to get paid. Thank you in advance.

SuperCoder Answered Fri 25th of March, 2016 03:36:45 AM

Hi!
First of all, as per guidelines, modifier 59 may be appended with column 2 code if there is CCI edit and modifier is allowed. So you should append modifier 59 with 67028 instead of 65800 since it is column 2 code.

Moreover, an ophthalmologist may remove aqueous humor from the anterior chamber (paracentesis-65800) prior to the intravitreal injection to avoid increase in intraocular pressure. So to report 65800, you need to check for the separate reason for paracentesis. Else you cannot bill 65800. Bill only 67028.
THANKS.

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