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validation results of 95903 and 95904 with 95861 different from Medicare

Brian Posted Wed 06th of February, 2013 16:37:41 PM

When I do a validation search for '95903'and '95904' reported on 1/4/12 with '95861' using the correct date range in the drop down box, the results show they may be billed with a modifer. However, when I check the table on the current Medicare website, the results show that from 1/1/12 to 12/31/12 '95903' and '95904' have a "0" in column 6 indicating they may never be reported with '95861'
Please clarify this.

SuperCoder Answered Tue 12th of February, 2013 19:18:39 PM

Brian Posted Wed 13th of February, 2013 20:21:23 PM

Ms. Godreau, I thank you for your answer but to be clear, are you telling me that the Medicare is not the primary source, but that Supercoder is and that I should be guided by Supercoder?
More importantly, your answer doesn't cover the 1st quarter of CY 2012 where my date of service in question (1/4/12)falls.

SuperCoder Answered Thu 14th of February, 2013 13:45:53 PM

Brian Posted Thu 21st of February, 2013 18:29:28 PM

The CMS URL for the current table I am referring to is:

http://www.cms.gov/apps/ama/license.asp?file=/Medicare/Coding/NationalCorrectCodInitEd/downloads/ccipra-v190r1-f2.zip

SuperCoder Answered Tue 26th of February, 2013 16:08:35 PM

The modifier indicator was reversed in CCI 18.3 from 1 to 0 with a retroactive effective date of the edits' date of inception: 2012001. SuperCoder will update CCI 18.0-18.2 to reflect that the pairs have a modifier indicator of 0, not 1.
Jen Godreau, CPC, CPMA, CPEDC

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