Wiki 97597 modifiers

Create Wiki Sort by date
M

Meeshimo

New
Messages
2
Best answers
0
When 97597 is billed with an additional procedure is a modifier (XS) required? Also, if this is performed during a post op period is a modifier required? I continue to have claims denied for incorrect modifier, and I've tried just about all of them. I need help! Thank you
 
0
For Medicare claims only, -XS is used on the additional procedure as long as it is a "separate structure/site".
Other payers will not accept the -XS, -XE modifiers, if you are billing non-Medicare use -59 on the additional procedure if it is performed on a separate structure/site.
If performed during a post op period YES it requires a modifier, look at modifiers -58, -78, -79.
The modifier to indicate global (-58, -78, -79) should be sequenced first, followed by the -XS or -59.
 
0
Hello, does this apply if it is a Medicare Replacement/Advantage plan? I have a claim that is during a post op period and it is being performed on the oppisite ankle/foot than that of the surgery. The claim outside of the postop period paid no problem. The 58 modifier doesn't apply since it isn't related to the procedure, there is no other procedure performed on dos so 59 isn't valid, and according to my system the 79 modifier isn't allowed.
 
0
fineamanda1 said:
Hello, does this apply if it is a Medicare Replacement/Advantage plan? I have a claim that is during a post op period and it is being performed on the oppisite ankle/foot than that of the surgery. The claim outside of the postop period paid no problem. The 58 modifier doesn't apply since it isn't related to the procedure, there is no other procedure performed on dos so 59 isn't valid, and according to my system the 79 modifier isn't allowed.
Click to expand...
79 would be the correct modifier in this situation. However, I've found that some payers don't allow that modifier on 97597 because that code isn't in the surgical section of CPT. In those cases, I've found they'll usually pay the procedure in the global without a modifier since it doesn't fall under either the E/M or surgical section for services that would be inclusive in a global period.
 
0
I'm coming in late here, but I have been researching this code also for another reason. I have a DX of L29.3 Anogenital pruritus, unspecified that according to the LCD is not covered for this service. I have asked the provider for more information. However, I'm not hopeful that this will be covered by Medicare. Also, now that I read your above messages, I can tell you that I just processed a claim using the XU modifier, not the 59 because it wouldn't work. Or I should say, I kept getting a flag. I will know by tomorrow if it passes through the scrubber. Keeping my fingers crossed. Any other thoughts on this would be helpful.
 
You must log in or register to reply here.
Top