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Modifier on 19083 and 19084

Pessie Posted Thu 03rd of October, 2019 15:57:01 PM
I am seeing many denials for cpt 19083 and 19084 from Wellcare only, stating: Missing modifier. All other insurances are paying this code without a modifier. Can you please advise what modifier will be necessary to get this biopsy paid? is it a 59? Please advise. Thank You
Pessie Posted Fri 04th of October, 2019 08:53:26 AM
PS 19083 is denied for missing modifier, and 19084 is denied because 19083 is denied
SuperCoder Answered Fri 04th of October, 2019 09:46:30 AM

CPT code 19083 is for Breast Biopsy for first lesion, whereas CPT 19084 is an add-on code (to CPT 19083) for each additional lesion.

There is no need to append any reimbursement related modifier, like 59 and/or 51, when you are billing only these two codes together, but not other than those codes (19083, 19084).

However, payer might demand to append the side determination modifier like RT/LT/50.

Check your medical document, append side identification modifiers and re-bill the claim.

Hope this helps!

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