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67900 and 67904

Jessica Posted Mon 12th of August, 2013 18:40:15 PM

Our surgeon does these two codes together. We are billing Medicare as the 67900 (50, 79) and 67904 (50, 51) and getting the 67904 denied for payment is included in the allowance for another service. As payment adjusted because the payer deems the info submitted doesn't support this service. Any coding advice?

SuperCoder Answered Mon 19th of August, 2013 20:01:45 PM

(67900 and 67904). There aren't any bundles for the two, so I don't know why the carrier is denying them. I've sent it along to my consulting editor for OPC; I'll let you know as soon she replies back.

SuperCoder Answered Thu 29th of August, 2013 10:50:33 AM

I'm not understanding why you are using modifier 79 on the 67900 code. This modifier is for a surgery performed during the postop period of another surgery that is unrelated. It is not used when another surgery is performed at the same time as this surgery.
Secondly, the primary procedure with the higher RVU's is 67904. This should not be modified with -51.
Finally, the services are not bundled and should have been separately paid but without seeing the actual EOB, I am at a loss as to why they were not both paid. It could be because of the inaccurate modifier use. The services should have been billed as follows:

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