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Joanne -CPC

Joanne Posted Thu 23rd of April, 2015 14:30:18 PM

We are having trouble with our VNG claims for the last quarter of 2014. We were billing codes- 92547, 92270-59,76 92546-59, 92546-59,76, 92542-59 per the instructions from the representative who sold us the equipment. We started receiving denials from Medicare starting Oct 1, 2014. What is the correct billing for these procedures for all of 2014, including any changes from October and how should we be billing for 2015?
Thank you very much, I am exhausted trying to find the correct billing for these procedures and medicare was not very helpful.
Any additional information about these codes is much appreciated. :)

SuperCoder Answered Fri 24th of April, 2015 11:01:18 AM

MUE is the medically unlikely edit and it’s value needs to be checked for the CPT when billing medicare. Its value for CPT 92546 is 1 which means you cannot bill 2 units for this code. This could be a possible reason for second unit denial for the CPT. In addition, CPT 92547 is considered included per CCI edits into CPT 92270, therefore append 59 modifier to it. You also need to make sure that the name of the ordering physician is on the claim which is a mandate by medicare otherwise the entire claim may get denied. Rest of the coding seems appropriate.

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