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96372 denials

Messages
5
Location
ENTERPRISE
Best answers
0
Our office is billing for an office visit (99214-25), J0702, 96372, & 69209. The admin fee (96372) is being denied by both Medicare and Blue Cross. What additional modifier is needed? I would greatly appreciate some feedback!
 

thomas7331

True Blue
Messages
2,042
Best answers
0
96372 bundles to 69209 (as it does to almost all surgical procedures) so would need a modifier 59 (or XE/XP/XS/XU) to unbundle it if the documentation supports that the injection was unrelated to the procedure.
 

Agilbert3

Networker
Local Chapter Officer
Messages
39
Location
SHREVEPORT/BOSSIER CITY
Best answers
0
Modifier 51

Hello,
I am wondering why the modifier 59 would be chosen. I would have chosen 51. It seems a bit silly to have to distinguish an ear lavage from an injection.
 

OncologyOKC

Networker
Messages
29
Best answers
0
Hello,
I am wondering why the modifier 59 would be chosen. I would have chosen 51. It seems a bit silly to have to distinguish an ear lavage from an injection.
You are not distinguishing an ear lavage from an injection. You are identifying that one service is not related to another; that the injection is a completely separate service from the lavage. (again, assuming that is the case; the earlier question is not exactly clear on what the 96372 is for)

Modifier 59 is typically used to override NCCI Edits. Code pairs not normally payable on the same date of service but may be paid in some circumstances when reported with an appropriate modifier (often modifier 59) and supported by documentation that demonstrates why the services are distinctly separate.
 
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