Wiki billing 93976 with 78656

[maryt310]

I am billing cpt code 76856 with 93976 -59, IBC keeps denying stating he Procedure Code 93976 on the claim denied correctly as per the NCCI benefits reported service is considered to be part of a service 76856 per codify 93976 can be billed with a modier , what am i doing wrong?

 

[CBLENNIE]

Were both procedures performed during the same session/encounter, if so, why would you bill 93976 in addition to 76856 since the services represented by 93976 are inclusive of 76856? Just because the codes can be billed together and the edit on 93976 can be overridden with modifier 59 doesn't mean it is appropriate to bill both codes. Because modifier 59 is frequently used incorrectly some payer will apply an edit in spite of the modifier being billed and your only option is to appeal the denial with records proving that the use of modifier 59 was appropriate.

However, if these services were not performed in the same session/encounter by the same provider, was 93976 performed first and then it was determined that the more extensive procedure 76856 was required to properly diagnose and treat the patient? If that is the case you might try billing modifier XE-Separate encounter, a service that is distinct because it occurred during a separate encounter, which will more specifically explain why the services are separate and distinct compared to modifier 59.

Per full definition of modifier 59:

Based on the section highlighted in pink I would say that you should be using modifier XE since it more appropriate to describe the services being distinct because they were done during separate sessions.