Wiki 11046 - 58-76

[cherylk11]

I have billed to Medicare procedure 11046-59 11047-76 they paid. Then billed week later 11043-58 11046-58-76 they denied. I thought maybe it should be modifier 59-76 but was told thats wrong. Any ideas?

 

[mitchellde]

I have billed to Medicare procedure 11046-59 11047-76 they paid. Then billed week later 11043-58 11046-58-76 they denied. I thought maybe it should be modifier 59-76 but was told thats wrong. Any ideas?

Why did you use the 76 modifier on the first submission? What is the reason for your modifier assignments. I do not see any repeated procedures which is what the 76 modifier is for. You have different procedure codes in each submission so it does not appear that any were repeated procedures.

 

[espressoguy]

I have billed to Medicare procedure 11046-59 11047-76 they paid. Then billed week later 11043-58 11046-58-76 they denied. I thought maybe it should be modifier 59-76 but was told thats wrong. Any ideas?

11046 & 11047 are add-on codes. I'm not sure why these would be paid without the primary codes. As Debra indicatated, modifier 76 would not be necessary. Also, there is no global on these procedures so modifier 58 would not be needed for the subsequent procedure (as well as the 76).