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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.
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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?
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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.
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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.
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Best,
Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Email: leesai@codinginstitute.com

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