Janet Posted Tue 14th of July, 2015 15:23:14 PM
We had been using a 59 modifier on the 43239 because of Medicare denials. In our recent audit we were told since they were not bundle no modifier was needed. We have recently stopped adding the 59 and are starting to see denials again stating these 2 codes are bundled. I am appealing these but wondered if you had and information you could share that I could include with the appeals. I was basically told these were in the same "family" and couldn't be billed together.
I appreciate your help.
SuperCoder Answered Wed 15th of July, 2015 00:54:16 AM
CCI edits do not show bundling issue between these codes. You should ask with your insurance company to provide policy or documentation, why they are denying it. Also, it has been seen that few payers paying these code combination with -51 modifier (multiple procedures). You can try this as well.