Wiki Billing 94640 with 94060

[Dgiannetto]

I am having trouble getting reimbursement on 94640 when I bill:

94060
94250
94640
94727
94729

Everything pays except 94640, the payer states that this code is inclusive to 94060?? I added a -76 as stated in the guidelines but it still won't pay. Any suggestions?

 

[Lamon Willis]

Modifier -59

Assuming documentation supports reporting the codes in question separately, you would need to utilize modifier -59 to bypass the National Correct Coding (NCCI) edits.

However, if this isn't the case, it is simply a payer-specific item which you would need to send an appeal letter for and explain why you expect separate reimbursement for the separate procedures.

 

[Dgiannetto]

I have tried the -59 without any luck. Documentation does support the code, and I don't see where it is inclusive to 94660, so I may have to send the appeal. Thanks so much for your input!