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Pulmonary codes

Billie Posted Tue 17th of January, 2012 16:47:27 PM

I checked the CCI edit for billing 94060, 94726, 94727 and 94729 together and the edit says it fine to bill with a 59 mod. of the 94727. In the CPT book it states; Do not report 94726 in conjunction with 94727, 94728. My Pulmonology department is asking what to bill.

SuperCoder Answered Wed 18th of January, 2012 07:26:41 AM

I will suggest not to bill 94727 (with 94626) when performed by same physician in same session and for the same medical necessity.

SuperCoder Answered Mon 23rd of January, 2012 20:38:30 PM

CCI Edits also include a scenario when a CPT although included in the another procedure completely should not be billed with the other CPT, but if there are some exceptional scenarios where these two codes can be billed together, then it allow both codes to be coded together with a modifier 59 for the inclusive code.
This code combination is of a rare scenario where can they can be billed together with a modifier, but by concept these two codes usually not billed together in most of the circumstances.

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