Medical Billing Coding - Incidental procedure modifier, cpt, codes
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Thread Topic: Incidental procedure modifier
Topic Originator: Jessica
Post Date November 10, 2015 @ 11:01 AM
Incidental procedure modifier


Jessica
November 10, 2015 @ 11:01 AM Reply  |  Email Friend   |  |Print  |  Top

Hello all! I have a question on usage of a modifier. A surgical procedure was denied, stating that it is incidental to the primary surgical procedure that was paid on the same day. Basically, they bundled the codes together. Insurance paid for 42145, but denied 42826. What modifier should I use to appeal the 42826? I'm thinking it would be a 59, but I just want to make sure before I submit the appeal. Thank you!

Coder Josh
November 16, 2015 @ 8:27 AM Reply  |  Email Friend   |  |Print  |  Top

of course use modifier 59, we do that with all claims and we get paid.

Coder Josh
November 16, 2015 @ 8:31 AM Reply  |  Email Friend   |  |Print  |  Top

of course use modifier 59, we do that with all claims and we get paid.

Janette
November 18, 2015 @ 8:43 PM Reply  |  Email Friend   |  |Print  |  Top

Always check for CCI edits!!

Mary Berard
January 12, 2016 @ 10:42 PM Reply  |  Email Friend   |  |Print  |  Top

The issue is not the modifier only with this issue. You should have two different Diagnostic code and link each one with each services. Then see if they are separate or part of the same services. If they are separate use 59 modifier, If they are just two separate surgical procedures for the same part Modifier 51, If the patient had surgery with in the same 90 days then modifier 78 and if in same global period but different diagnostic us modifier 79. All these things should be evaluated before appealing the claim. Thanks



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