Wiki Modifer 76 on Repeat Stages and MEdicare Denials as duplicates

[mbsolutions]

Default Mohs Denials as Duplicates
In addition: Has anyone seen Medicare denying stages billed on separate lines as duplicates? We are in Palmetto GBA J1 Southern Cal. They were paying successfully like this. All of a sudden, Medicare is paying 17311, 17312 X3 Units, denying lines 3-5 (5th, 6th & 7th Stage) and paying the 6th line (8th stage) with the mod 76. When we called, they said Mod 76 is not appropriate, yet they paid a line item with the Mod 76.

We were advised in 2009 by Inga Elzey Practice group to start billing multiple stages as follows:

if pt has total of 8 stages:

17311 1 unit
17312 3 units
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit

Any feedback would be greatly appreciated.

 

[twizzle]

Cpt 17312

Default Mohs Denials as Duplicates
In addition: Has anyone seen Medicare denying stages billed on separate lines as duplicates? We are in Palmetto GBA J1 Southern Cal. They were paying successfully like this. All of a sudden, Medicare is paying 17311, 17312 X3 Units, denying lines 3-5 (5th, 6th & 7th Stage) and paying the 6th line (8th stage) with the mod 76. When we called, they said Mod 76 is not appropriate, yet they paid a line item with the Mod 76.

We were advised in 2009 by Inga Elzey Practice group to start billing multiple stages as follows:

if pt has total of 8 stages:

17311 1 unit
17312 3 units
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit

Any feedback would be greatly appreciated.

17312 is an add-on code so you would not put a modifier on it. After all, it refers to "each additional" ( as far as I'm aware..I don't have a codebook in front of me). "Each additional" is work on more body area which is not the same as a repeat procedure such as taking an x-ray of the same area several times. You will have to use units and no modifier.
Hope this helps

 

[mitchellde]

you use the 59 not the 76, it is not a repeated service when it is performed on a different area in the same session it must be a separate session to be a separate procedure. You bill each additional procedure separate with 1 unit and a 59 modifier to keep it from denying as a duplicate entry. Multiple units are not to be used on surgical services. In the MCM it states that units greater than 1 may be used on services distributed in quantities only and they use the example of oxygen administration which is administer per hour. the CPT book each additional and then instructs that you are list separately. The denial is correct 76 is an invalid modifier for this code.

 

[CFisher5]

Default Mohs Denials as Duplicates
In addition: Has anyone seen Medicare denying stages billed on separate lines as duplicates? We are in Palmetto GBA J1 Southern Cal. They were paying successfully like this. All of a sudden, Medicare is paying 17311, 17312 X3 Units, denying lines 3-5 (5th, 6th & 7th Stage) and paying the 6th line (8th stage) with the mod 76. When we called, they said Mod 76 is not appropriate, yet they paid a line item with the Mod 76.

We were advised in 2009 by Inga Elzey Practice group to start billing multiple stages as follows:

if pt has total of 8 stages:

17311 1 unit
17312 3 units
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit
17312 mod 76 1 unit

Any feedback would be greatly appreciated.

I think that my first question would be why did you bill that way? When you bill add on codes they should be billed in units, not seperate. The claim should have been billed 17311 X1 and 17312 X7. If the stages with modifier 76 were done on another lesion or if they were suposed to be billed as additional blocks, then the wrong codes were used and the denial is justified.
____________________

Cortney, CPCD

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