BCBS denial of 36010

kcolum81

Networker
Messages
63
Location
Bradenton
Best answers
0
Below are the cpt codes I am billing for a heart cath. Can anyone help me with acceptable modifiers for BCBS?

93563
93565
93531-26
93567
75825-26
75827-26
36011-LT
36215-59
36216
36010 (IVC)-50
36010 (SVC)-50

BCBS keeps denying 36010 saying it is inclusive of another code.
Thanks to anyone who can help!
KC
 
Messages
174
Location
Durham, NC
Best answers
0
Hello kcolum81,

There is a CCI edit when CPT 36010 is billed along with CPT 93531 & CPT 36011. Since CPT 36010 is a column two code you will need to apply an appropriate modifier (59/XS etc..) .

Hope this helps~
 

cgaston

Expert
Messages
465
Best answers
0
The documentation would have to support that the IVC and SVC were performed for something outside of the cardiac catheterizations in order for them to be separately reimbursable.

It wouldn't matter that you have modifiers if the documentation does not support they were separately identifiable procedures.
 

kcolum81

Networker
Messages
63
Location
Bradenton
Best answers
0
The documentation would have to support that the IVC and SVC were performed for something outside of the cardiac catheterizations in order for them to be separately reimbursable.

It wouldn't matter that you have modifiers if the documentation does not support they were separately identifiable procedures.
IVC - "...to evaluate the Fontan."
SVC- "...to evaluate for any venovenous collaterals."

Would this qualify? Thanks so much for your help Cgaston!
 

cgaston

Expert
Messages
465
Best answers
0
So it looks like the patient had a Fontan procedure and they are checking it?


I would try appealing the denial explaining the unusual circumstance and add the diagnosis for a corrected congenital heart malformation (Z87.74) on the two along with -59 on both.

This is not a guarantee of payment but it is worth a shot!
 
Top