Wiki 90792 & 90687, modifier assistance, Medicare

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abrintle

Networker
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Location
Youngsville, NC
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Can anyone offer any insight on how to bill 90792 and 90867 performed on the same DOS to Medicare. No specific LCD as this practice is nationwide.

We have tried:
90792, 25 and 90867, 59...90792 pays and 90867 denies
90792, 25 and 90867...again same result

Other payors are paying with 90792, 25 and 90867, 59...just not Medicare. BCBS requires 58 on the 90867. We thought about trying 58 with Medicare, but want to do some research first. We have done lots of research, so I was hoping reaching out to you guys might help.

Thank you in advance for your assistance,
Ashley Brintle, CPC
 
According from AAPC coder you can not bill 90792 and 90867 per this statement:
Code 90867 is a column 2 code for 90792. You may not override the edit.
CCI Edit Rule:
CPT Manual or CMS manual coding instructions
I hope this helps
 
Thank you! Isn't it funny how Medicare has different rules than other payors. Other payors pay these just fine w/ the appropriate modifiers.
 
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