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76830, 76856 this was paid but i getting denial CO-4 on 76857 bill 20 days later

Mariana Posted Fri 17th of February, 2012 19:54:35 PM

do i need a modifier ? 59?

SuperCoder Answered Fri 17th of February, 2012 21:01:18 PM

Hi Mariana.
I just want to be sure I am understanding -- are the dates of service 20 days apart or are you filing the claims 20 days apart but the DOS is the same?
76857 is bundled with 76856 (though modifier 59 can be used under the proper clinial circumstance), but that wouldn't apply if the ultrasounds are performed 20 days apart.
Not knowing what type of provider you're billing for, is 26 appropriate? Could that be what you're missing? Did you use any modifiers? CO-4 can also mean the code is inconsistent with a modifier you did submit.
Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute

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