betsycpcp
Networker
As of 1/1/19 NCCI shows 95972 in column 2 so that it bundles with 63650. It says reason is "CPT Manual or CMS manual coding instructions" but I can't find anything in the NCCI Policy Manual or the Medicare Claims Processing Manual about it. I don't have a hard copy of the 2019 CPT manual but I checked Optum Encoder Pro and Revenue Cycle Pro, and can't find anything at all showing CPT manual instructions or Medicare instructions explaining this edit.
I work for a payer and a provider is questioning our denial. They used modifier 59, but the documentation needs to support that. However with no explanation of why there is an edit all of a sudden for 2019, I don't know what does or does not justify billing with modifier 59.
I tried searching on Google and got absolutely nothing. Has anyone run into this and do you know that the rationale is?
Thanks in advance for any insight. If you have a reference from some official source please let me know what that is and/or quote it if you can.
I work for a payer and a provider is questioning our denial. They used modifier 59, but the documentation needs to support that. However with no explanation of why there is an edit all of a sudden for 2019, I don't know what does or does not justify billing with modifier 59.
I tried searching on Google and got absolutely nothing. Has anyone run into this and do you know that the rationale is?
Thanks in advance for any insight. If you have a reference from some official source please let me know what that is and/or quote it if you can.