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CCI edit and Mod 59

Deb Posted Mon 18th of July, 2011 17:30:18 PM

Do you bill the colunmn 2 code with the column 1 code of a code pair edit even if you are NOT putting the modifier 59? For example - doctor order a thyroid ultrasound and a carotid artery ultrasound. Both were done during the same patient encounter, so I am not appending modifier 59 on 93880. Should I even be billing 93880 when I know it will be denied as not paid separately?

SuperCoder Answered Mon 18th of July, 2011 19:52:59 PM

Since 93880 and 76536 are mutually exclusive, the one with higher RVU, i.e., 93880 should be billed with modifier 59. Here 93880 is a column 2 code for cpt 76536.

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