Wiki 36245 & 75630 denied

[coders_rock!]

2010 claim

93510(26)- paid
93543 - paid
93545 - paid
93555(26) - paid
93556(26) - paid
36245 - not paid
75630(26) - not paid

why are these not being paid?

Thanks for all your help...

 

[Cyndi113]

Without looking at the report - add -59 modifier to 36245 and 75630 but ONLY if they were performed as separately reportable procedures.

 

[theresa.dix@tennova.com]

Without looking at the report - add -59 modifier to 36245 and 75630 but ONLY if they were performed as separately reportable procedures.

Yes and you have to have a payable dx.

 

[amym]

What makes these 2 procedures seperately reportable or under what circumstance can they not be billed seperately?

 

[Jim Pawloski]

2010 claim

93510(26)- paid
93543 - paid
93545 - paid
93555(26) - paid
93556(26) - paid
36245 - not paid
75630(26) - not paid

why are these not being paid?

Thanks for all your help...

I think the reason they are not getting paid, is that 75630 is a non selective charge. 75630 is a Abdominal aortogram with distal run-off from a single catheter position. 36245 is a selective catheterization. If this a Medicare patient, then use G0290 for 75630.

HTH,
Jim Pawloski, CIRCC

 

[rpcarrillo]

If this a Medicare patient, then use G0290 for 75630.

Perhaps you mean G0278 for non-selective iliac angio during cardiac cath instead of G0290 (the Medicare code for DES stenting)? If so I agree, putting 36245 and 75630 together as presented makes me suspect there's an issue with the way the account was coded originally. Impossible to tell without the op report though.

 

[Jim Pawloski]

Perhaps you mean G0278 for non-selective iliac angio during cardiac cath instead of G0290 (the Medicare code for DES stenting)? If so I agree, putting 36245 and 75630 together as presented makes me suspect there's an issue with the way the account was coded originally. Impossible to tell without the op report though.

Your right, I was trying to use my memory during lunch when I wrote this. Not good!