Question 94640 abd 94664 denial

Christal

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We performed testing on a patient for asthma. I billed the visit as follows:
94070
95070
94640-59
J7674
J7674-JW
J7613
94664-59
All was paid except the 94640 and 94664. The 94640 is column 2 edit to 94070 and the 94664 is column 2 edit to 94640. I billed both with modifier 59 and they are both denying for modifier not supported. Could someone please help me understand or figure out what I have done wrong? This is a Tenncare patient.
 

Christal

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Why do these codes qualify for a modifier -59?
They are column 2 edit and says will pass through with modifier. One is inhaler instruction and the other is for a breathing treatment given in the office. If the 59 is not correct, would you know which modifier to use for this? The modifiers that show on the codify to use are not appropriate except the 59, when ran through the CCI edit.
 
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Orthocoderpgu

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I code surgeries. When two surgical codes hit an edit, if both procedures were performed through the same incision the codes would not qualify for a -59 modifier. If the two procedures were performed through separate incisions, they could qualify for a -59 modifier. You have two codes that hit an edit. Depending on the circumstances they may bundle and only one can be reported, or they may not bundle and both can be reported. So in this circumstance, what makes them qualify to be billed together vs being bundled? Just because the NCCI states the codes are allowed with a modifier does not mean that you can automatically just add a -59 and bill both. They have to qualify for a modifier, otherwise they bundle.
 

Christal

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The 94640 may be considered bundle with the 94070. She had a methacholine challenge to check for asthma and she dropped and required a breathing treatment so I billed the 94640. After further research it states under the 94640 it is excluded with other respiratory services (94060, 94070). When I check the code 94664 in the book it does not have any exclusions listed and was denied as not supported with the 94640. I assume at this point it that was denied because the 94640 is considered in payment with the 94070. I could possibly resubmit corrected claim without the 94640.
 

Orthocoderpgu

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The 94640 may be considered bundle with the 94070. She had a methacholine challenge to check for asthma and she dropped and required a breathing treatment so I billed the 94640. After further research it states under the 94640 it is excluded with other respiratory services (94060, 94070). When I check the code 94664 in the book it does not have any exclusions listed and was denied as not supported with the 94640. I assume at this point it that was denied because the 94640 is considered in payment with the 94070. I could possibly resubmit corrected claim without the 94640.
94640 hits an edit with 94664 & 94070. So unless the codes qualify for a modifier -59 or similar modifier, sending it a corrected claim without 94640 seems to be reasonable.
 

Christal

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Why do these codes qualify for a modifier -59?

94640 hits an edit with 94664 & 94070. So unless the codes qualify for a modifier -59 or similar modifier, sending it a corrected claim without 94640 seems to be reasonable.
That is what I was thinking after looking more into this. Thank you for your help.
 
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