64493, 64494, 64495, 20610 CCI Conflict/Denials

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Hi,

I am having an issue when billing codes 64493, 64494, 64495 and 20610 together.

When you plug these codes into optum Encoder it puts 64493 as primary over 20610. But then it also states that 20610 is primary over 64494, and 64495.
We have been billing these codes as
64493
64494
64495
20610-59.
The insurance is paying for the 64493 and the 20610. But is denying the 64494 and 64495. Our AR team wants us to add 59 modifiers to the 64494 and 64495. But these are add on codes so they should not require a 59 modifier.
If this was happening for 64494, and 64495. Why does CCI not also have the edit in place for 64491, and 64492??

The AR Department contacted medicare and they gave us this response.
"Medicare is stating that a modifier is needed to clear the CCI Edit between the 64494 and the 20610 even though it is an add on code.
The documentation provided from CMS supports the appending of the 59 to the add on code and shows that there are add on codes that do have CCI edits"

I as a medical coder have never seen an instance where a 59 modifier is required on an add on code like this. I would not think this is "Correct Coding" As we are not supposed to just add a 59 in order to get something paid.
Can someone please help me out with this ?
 

torresreb

Networker
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