Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Anesthesia
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 10-13-2009, 11:33 AM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default 95904 as 12 units

Our physician performed 12 units of 95904. I know that Appendix J of the CPT code has a recommendation of 6 units for bilateral CTS testing. I wanted to seek some opinions and see if anyone was using modifier GD.

GD="Units of service exceed medically unlikely edit value and represents reasonable and necessary services."

Also, I've been reading a great deal of literature on Neurodiagnostic testing and wanted to get some input on how you bill the units when they are in excess of the recommendation allowance. In my scenario, I could bill...

1) 95904 x12 units on a single line or 2) separate the sensory NCS into two line items, such as 95904 x6 on one and 95904 x6 on the other. (with modifier 59 on the 2nd line)

The thought was that 95904 x 6 and 95904 x 6-59 would be a better coding scenario since a payer is likely to deny all 12 units instead of allowing 6 units and denying 6. I'm hearing that many payers will process the first line and deny only the second line for the additional units. This way...you only need to work those units that are out of the "norm" and appeal the remaining with medical necessity.

Anyone experiencing this?
Reply With Quote
  #2  
Old 10-13-2009, 11:39 AM
mitchellde's Avatar
mitchellde mitchellde is offline
True Blue
 
Join Date: Apr 2007
Location: Columbia, MO
Posts: 8,312
mitchellde will become famous soon enoughmitchellde will become famous soon enough
Default

Rebecca,
When we tried billing these codes with units greater than one, every claim failed for units out of range. Then we started billing each line item with one unit and used the 59 modifier, and every line item paid. This was Medicare as well as every commercial carrier we used. I had experienced the same thing many years ago when I worked in the facility, and had the same outcome. Just my 2 cents here.
__________________

Debra A. Mitchell, MSPH, CPC-H
Reply With Quote
  #3  
Old 10-13-2009, 12:19 PM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default

Thanks Debra...We're not experiencing issues with units of 6 or under. I've checked our LCD and it appears that our particular Medicare carrier had adopted CPT's table of recommendation. I'm really intrigued by the GD modifier and it's acceptance by the carriers...
Reply With Quote
  #4  
Old 10-13-2009, 05:51 PM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default

No one else deals with this procedure?? Interesting............
Reply With Quote
  #5  
Old 10-14-2009, 01:52 PM
Walker22 Walker22 is offline
True Blue
 
Join Date: Apr 2007
Location: Athens, Ga.
Posts: 530
Walker22 is on a distinguished road
Default

We bill this code to Medicare and others and have had no trouble getting paid for multiple units, but we rarely exceed 4 units. I have no experience with the modifier you mentioned.
Reply With Quote
  #6  
Old 10-15-2009, 06:28 AM
RebeccaWoodward* RebeccaWoodward* is offline
True Blue
 
Join Date: Apr 2007
Location: North Carolina
Posts: 3,129
RebeccaWoodward* will become famous soon enough
Default

Thanks for your feedback...
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 03:49 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC