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Use of 67036 with 67121

Chery Posted Tue 23rd of June, 2015 13:06:54 PM

Doctor performed PPV (67036) with removal of silicone oil (67121). Medicare NY denied the 67036. Is there another code or modifier I can use to have this paid.

SuperCoder Answered Wed 24th of June, 2015 00:46:56 AM

According to CCI edits Code 67036 is a column 2 code for 67121 , but a modifier is allowed in order to differentiate between the services provided. If your documents support viterectomy as a distinct procedure that means it was not performed to complete the removal of silicon oil implant (i.e., not a incidental procedure) but was performed for other purpose with some other medical reason. You can submit the claim for rebuttal/reconsideration with CPT 67036-59 modifer and with different specific diagnosis code.

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