Wiki 20610 - Different area, same side - Help!

[Sdrivera]

Hello! Any help would be greatly appreciated!

I've read through several forum questions in regards to billing 20610 multiple times on the same claim because it was performed bilaterally at different areas. I haven't located anything to give me guidance on billing 20610 at different areas but on the same side of the body. Please see the claim details below. Payer is Medicare (TX). All line items paid EXCEPT #4 - 20610 at the right hip. The denial is "CO-16: Claim/service lacks information or has submission/billing error(s); N519: Invalid combination of HCPCS modifiers.

Claim details below:

ICD-10:
1) M70.61
2) M17.11

CPT	ICD-10
1) 99204-25	1, 2
2) 73562-RT	2
3) 73502-RT	1
4) 20610-RT-59	1
5) J3301-RT	1, 2
6) 20610-RT-59	2

 

[rthomas@impcna.com]

Hello! Any help would be greatly appreciated!

I've read through several forum questions in regards to billing 20610 multiple times on the same claim because it was performed bilaterally at different areas. I haven't located anything to give me guidance on billing 20610 at different areas but on the same side of the body. Please see the claim details below. Payer is Medicare (TX). All line items paid EXCEPT #4 - 20610 at the right hip. The denial is "CO-16: Claim/service lacks information or has submission/billing error(s); N519: Invalid combination of HCPCS modifiers.

Claim details below:

ICD-10:
1) M70.61
2) M17.11

CPT	ICD-10
1) 99204-25	1, 2
2) 73562-RT	2
3) 73502-RT	1
4) 20610-RT-59	1
5) J3301-RT	1, 2
6) 20610-RT-59	2

For line # 4 I would have used modifier 51 to indicate multiple procedures them list 59 to indicate separate site
20610-RT-51-59.

 

[amyjph]

This is Noridian but may help. You wouldn't append a 59 to both lines. You could do as suggested above by @rthomas@impcna.com, however Medicare does not normally want modifier 51 and it doesn't always make sense to use a 51 on codes with the same RVU. Try as suggested in the link below, 2 units one line both dx codes RT mod. You could also try one line, one unti w/ 20610-RT, and the other line one unit with XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure”. Depends on the payer and/or MAC.
See scenario 5 & 6