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Old 01-15-2013, 01:46 PM
jessica1974 jessica1974 is offline
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Default Modifiers for Coronary Arteries

We have just starting coding and billing out the new cpt codes for stents. Today I received denials on all my stent codes. The denials were for the modifiers of RC, LD, and LC. I spoke to a Medicare representative who is stating that these modifiers are no longer required for these codes. Is anyone else getting denials with these modifiers? If not you might want to start looking because you probably will. Just wondering if anyone was aware that these are no longer needed. According to the research I have done it looks like maybe you use them when doing 2 different artery. However Medicare is stating they aren't being used at all. Anyone have any information on this new development?
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Old 01-21-2013, 01:00 PM
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We haven't received any denials or payments so far from Medicare or any commercial payers. I haven't heard of this at all and I'm surprised they are doing it. Maybe its MAC specific and not CMS specific?? What MAC do you have in West Virginia?? We have Noridian out here.
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Old 01-21-2013, 01:35 PM
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Yes, we've been receiving them for a while. Just delete and rebill your corrected claim
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Old 01-22-2013, 10:44 AM
jessica1974 jessica1974 is offline
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Our MAC is Palmetto GBA. They deny any of the intervention codes that have modifiers appended. I have been deleting the modifiers and resubmitting. Waiting to see if we receive payment this way. It is surprising that when you are coding 2 interventions on the same DOS they do not want the modifiers. I even called the Provider Service line and they looked up the code. I was told that under those codes only the LM and RI were listed as modifiers that could be used. I have researched and there is no mention of this anywhere. But when you submit the claim they reject it. I wish they had put out a policy or a forum that made people aware of this new change. Oh well..hoping that things get payed once the modifiers are deleted.
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Old 01-22-2013, 12:47 PM
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yeah, hopefully that will solve the issue but it still doesn't make sense. Maybe its an error on their part?? they are thinking since the new modifiers came out this year that those are the only modifiers now?? I don't know but please keep us updated and I will too as soon as we receive payments or denials.
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Old 01-28-2013, 11:16 AM
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I am having this issue also. Our MAC is First Coast. I have researched hours and cannot find anything on the CMS site or First Coast. Does anyone have any updates to this issue?

Thanks,
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Old 01-28-2013, 12:43 PM
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Default Modifiers with new stent codes

We are Noviats in PA, anybody else in PA getting denials for using the modifiers with the new stent codes? thanks. Sandy
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Old 02-04-2013, 09:58 AM
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I'm in Wisconsin and finding out as well now that all my interventions with the vessel modifiers are being denied. Can't imagine why they wouldn't want them!

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Old 02-04-2013, 10:06 AM
jessica1974 jessica1974 is offline
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I have been using Jim Collins crosswalk and he states when you do 2 stents in different vessels to use the modifiers for those vessels. So I have been adding them only when I am coding 2 stents in different vessels. Today I received my first denial from Medicare on 2 stents with the modifiers LD and LC appended. Denied for inconsistent modifier.again.. just like when you code for one stent. It appers they don't want any modifiers on any interventions.
As terrible as this sounds I am glad that I am not the only one receiving denials on this issue. If anyone has any suggestions or any tips for this situation please keep me posted.
Thanks.
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Old 02-04-2013, 11:55 AM
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Quote:
Originally Posted by jessica1974 View Post
I have been using Jim Collins crosswalk and he states when you do 2 stents in different vessels to use the modifiers for those vessels. So I have been adding them only when I am coding 2 stents in different vessels. Today I received my first denial from Medicare on 2 stents with the modifiers LD and LC appended. Denied for inconsistent modifier.again.. just like when you code for one stent. It appers they don't want any modifiers on any interventions.
As terrible as this sounds I am glad that I am not the only one receiving denials on this issue. If anyone has any suggestions or any tips for this situation please keep me posted.
Thanks.
I likewise would like any suggestions myself. This is ridiculous. I had our Medicare clerks contact Medicare and they were told that the modifier I used (LC & RC) for a particular patient were invalid modifiers and we need to correct the modifiers and re-submit. Uggh what a pain.

Jessica CPC, CCC
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