Medical Billing Coding - 99253 billed with 92980/92981/93458, cpt, codes
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Thread Topic: 99253 billed with 92980/92981/93458
Topic Originator: Lucy Peterson
Post Date July 26, 2012 @ 4:19 AM
99253 billed with 92980/92981/93458


Lucy Peterson
July 26, 2012 @ 4:19 AM Reply  |  Email Friend   |  |Print  |  Top

HMSA denied 99253 and 93458 when I billed those 4 procedure codes for one service date. The reason for that denial is 'This unbundled procedure is part of a more comprehensive code that describes the entired procedure performed'.

Should I use a modifier 25 or 51 for 99253 to avoid denial.

Any suggestion please?

byronmb
July 26, 2012 @ 11:54 AM Reply  |  Email Friend   |  |Print  |  Top

We use modifier 59

Lucy Peterson
July 26, 2012 @ 8:54 PM Reply  |  Email Friend   |  |Print  |  Top

Thanks. I will use modifier 59 for 99253.

What about 93454/93458 (heart cath)? I use modifier 26 for them, but still they were denied as unbundled. Should there be a secondary modifier like 51 or 59 for them please?

Byronmb
July 27, 2012 @ 9:46 AM Reply  |  Email Friend   |  |Print  |  Top

We use 59 with all codes

Theresa
July 27, 2012 @ 12:51 PM Reply  |  Email Friend   |  |Print  |  Top

99253 is a consultation code. You need to add 25 modifier on it and the 59 modifier onto the 93458. Also onto the 92980 and 92981 you would need LD LC or RC to indicate which vessel was treated.

Should look like this
99253-25
93458-26-59
92980 LD
92981RC              example

Lucy Peterson
July 27, 2012 @ 9:45 PM Reply  |  Email Friend   |  |Print  |  Top

Thank you so much for all your help!

ilsbio
September 13, 2012 @ 6:19 AM Reply  |  Email Friend   |  |Print  |  Top

We use modifier 25 and 59. 25 does not work with each, 59 will get you done surely. Also you can try 26.

<a href="http://www.ilsbio.com">biobanks</a>



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