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Denials for wound care billing

Charles Posted Mon 23rd of January, 2017 15:43:05 PM
I keep getting denials from a medical group when billing the following on a single claim cpt listed in order as on hcfa form: G0168 (claim denies as code bundled into 97597/per medicare guidelines) 97597 GP, 59 Modifier (ONLY PAYS THIS PROCEDURE) 29580 59 (same as above denial) 29530 59 (same as above denial) I get same denial when billing w/modifier 51. I look at medicare guidelines and it appears to allow w/proper modifier. I bill this same way w/medicare and medicare pays all the time w/59 modifier. I bill for an infectious disease physician.
SuperCoder Answered Tue 24th of January, 2017 04:03:43 AM

Greetings from SuperCoder.com!

 

Please note that G codes are used by Medicare. Please check with your payer regarding their preferences prior to submitting the claim. Often, private payers use the CPT® simple repair codes, specifically 12001 through 12018. For codes 29580 and 29530, you may use modifier 59 if you have documentation to support modifier 59.

 

Please feel free to write if you have any concern or questions.

 

Thanks.

Charles Posted Tue 24th of January, 2017 09:46:19 AM
For private payers should I use modifier 51 vs 59 with the 29580 ad 29530?
SuperCoder Answered Wed 25th of January, 2017 01:21:55 AM

Hi,

 

Payer specific policy may be the determining factor while choosing modifiers 51 and 59. Some payers do not accept modifier 51 (e.g. Medicare contractors). So please read your payer’s policies carefully and bill accordingly.

 

Thanks.

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