Wiki 7000 codes w/ a 80 modifier

[butterfly13]

Our practice has been getting denials from Medicare for the 7000 codes billed with a 26 and 80 modifier. We used to get paid for these services but, since Medicare switched over to Palmetto, they are now being denied.

Are any other vascular practice's coming across this same problem?

I am questioning how to go about getting paid for these or if these are new non- covered services?

Under the CCI edits it does state that an 80 is allowed with documentation but Medicare is still denying.

Please contact me at kcommon@pssmg.com if you have any info on this.

Kristen Common, CPC

 

[LLovett]

Are these being billed twice? Once under the main surgeon and then again as the assistant? If they are I am not surprised that Medicare is not wanting to pay for the reading twice. If the assistant surgeon is the only one interpreting I would think it would be billed under their name will just the 26 modifier.

Laura, CPC