Diana Posted Wed 14th of February, 2018 20:33:41 PM
we billed medicare: 99203, 73564, 77073
dx billed: M17.11: right knee for all codes
Medicare paid 99203 and 77073.
There was no payment on 73564 (column 2 code for 77073)
73564 denied: cob15- requires qualifying service/procedure (per rep, Bundled)
We know that a modifier -59 can be added to receive payment but SHOULD it receive payment? if it happens here, it will continue to happen and we do not want to abuse this modifier --
per the note, the xray was on the knee and it was used to incorporate varus deformity of the mid tib-fib non-malunion. is this determining factor in this case to use modifier -59? if not, what would constitute using the modifier in a situation like this?
SuperCoder Answered Thu 15th of February, 2018 01:07:13 AM
CPT code 77003 includes radiological examination of the lower extremities. CPT code for radiological examination of the lower extremities should not be reported in addition to the CPT code 77073 for examination of the radiological films for bone lenghth study. However, if a seperate and distinct radiological examination is performed with additional films of a specific area of lower extremity to evaluate a different problem, than you can report with appropriate modifier.
In your case, since the xray was for to check for varus deformity of the mid tib-fib non-malunion you can report the code 73564 with 59 modifier.
Hope that helps!