Ana Posted Wed 11th of April, 2018 11:16:52 AM
WHEN BILLING AN MRI AND MRA OF THE BRAIN ON THE SAME DAY, WHAT MODIFIERS SHOULD BE USED? WE HAVE BEEN USING XS AND XU BUT THEY ARE DENYING FOR MEDICAL NECESSITY
SuperCoder Answered Thu 12th of April, 2018 08:17:31 AM
Modifier XS states “Separate Structure, A service that is distinct because it was performed on a separate organ/structure hence Modifier XS is not appropriate for above scenario, Modifier XU can be appended to unbndle two codes as stated above. The denial reason is for item or service expected to be denied as not medically necessary is when there is no ABN for the service on file. Please check for ABN. if an ABN is not signed by the beneficiary then append modifier GZ.
Hope this helps!
Ana Posted Thu 12th of April, 2018 08:46:22 AM
Would modifier 51 be appropriate? They are paying the MRI of the brain but denying the MRA. 51 is multiple procedures performed on the same date of service. We have the documentation to support both procedures.
SuperCoder Answered Fri 13th of April, 2018 06:53:01 AM
As per NCCI edit to unable the bundling edit of codes only modifier 59 or XE, XS, XP, XU is used. Modifier 51 Multiple Procedures: use Modifier 51 to indicate that multiple procedures (other than E/M) were performed at the same session by the same provider. Use modifier 51 on the second and subsequent operative procedures when the procedures are ranked in RVU order. Hence you can append modifier 51 But NCCI hit would be unbundle by 59/XS/XE/XU/XP only. Try to bill this claim with modifier 59 as some payers doesn't pay for XE/XS/XP/XU.
Hope this helps!