Wiki RFA on back to back days

[missyah20]

Hey -

My provider did a lumbar RFA on the left side on one day. The patient returned the very next day and had lumbar RFA on the right side.

I already have the LT/RT modifiers on the claim and resubmitted with a 76 for the second day, but Medicare has denied as unprocessable (MA130).

Any ideas on what I can use to help get Medicare to process this?

 

[mhstrauss]

Hey -

My provider did a lumbar RFA on the left side on one day. The patient returned the very next day and had lumbar RFA on the right side.

I already have the LT/RT modifiers on the claim and resubmitted with a 76 for the second day, but Medicare has denied as unprocessable (MA130).

Any ideas on what I can use to help get Medicare to process this?

Modifier 76 isn't appropriate in this case; that mod is only used when the repeat service is performed on the same day.

RFA's have a global period, so a "post-op period" modifier is needed on the right side...79. Was the left side denied also?

 

[dwaldman]

I believe the second day would be reported with modifier 58 for staged procedure if at the time of the first procedure it ws planned to do a staged procedure the next day.

Modifier 58 Fact Sheet
Definition
Indicates a staged or related procedure or service by the same physician* during the postoperative period
Appropriate Usage
To report a staged procedure planned at the time of the original procedure

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier-58.shtml

 

[missyah20]

Hey - thanks for the responses. I just check the operative note for the Left side RFA and the right side was a scheduled procedure at that time. I think I am going to try the 58 here.

Thanks again.