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drampas3418

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Toms River, NJ
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hi , i am now running into an issue that is new with nj medicare. i billed out the following 17261, 17261-59, 17261-59, one was denied so i added a modifier 76 to the one denied.that was denied. 2 of the destructions had the same diagnosis and only one was paid, so i am thinking maybe i needed to bill out a quantity of 2? i just called medicare and added the quanitity so i dont know if this will pay now or not. does anyone have any experience with this denial?
 
i have 2 different diagnosis but 2 have the same dx. one is a bcc and the other is an scc. the dx is not the issue though except that 2 have the same dx as they are scc on the trunk times 2
 
We are having the same problem with a UHC claim (two malignant destructions with same diagnosis). We billed on two lines, with a 76 on the second, and it was denied.

I don't have an answer about how to bill these. Does anyone know?

Should we bill two units on one line?... Two lines with a 59 on the second? (but drampas3418 got a denial this way)... Two lines with a 76 on the second? (but we got a denial this way)

Does anyone know???
 
Was the entire claim denied, or just the second line, what was the denial reason? UHC often has updates to their claim adjudication system and you don't find out until claims are denied. I would bill on 1 line and change the quantity 2 for this. Of course, make sure that the payment reflects both procedures. When billing on 2 seperate lines with mod 59, you may receive a partial payment, but the 2nd line may deny as a dup, and they will just require you to send in records.
 
The Medicare claim needs to billed on 1 line, and change to quantity to 2, or accordingly.. NGS is our MAC and they recently sent out a bulletin on how to bill for multiples of the same procedures, and this is what they instructed.
 
Thanks a lot for your reply! We'll trying billing as two units on one line, as you suggest - and yes, when we get paid, we will compare the payment with the allowances to make sure they are paying for two, not one!
 
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