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  1. Leorah Posted 2 month(s) agoRelated Topics

    Our patient was admitted to the hospital and received a Diagnostic Cerebral Angiogram. Later on in the day another totally separate and different procedure, a lumbar puncture was performed on the patient by the same doctor. When submitting the claims the insurance company applied multiple same day surgery rules to the lumbar puncture 62270 code. I was under the impression that multiple surgery rule discount is justified only if all the work to set up for the surgery was done in the same session for another procedure and therefore less set up work is required. When the provider has to start a new session for a procedure from scratch the set-up work has not been paid for yet and therefore the full bill charges need to be maintained. Please explain and if I am correct please give me the tools to appeal this claim.

  2. SuperCoder Posted 2 month(s) ago

    Hi, 

    As per CMS  if the two procedures are performed at separate anatomic sites or at separate patient encounters on the same date of service, modifier 59/XE may be appended to indicate that they are different procedures on that date of service

    Please refer undermentioned link for more clarification. 

    https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

     

    Hope this helps!

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  • Posted by 115517 Leorah, 2 month(s) ago. There are 2 posts. The latest reply is from SuperCoder.