Wiki billing question

[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?

 

[Orthocoderpgu]

Full disclosure, I code orthopedic surgeries so this is not in my line of work. Since there is an edit between the codes in order to bill both with a modifier, they have to qualify for the -59 modifier. In this case what makes both of these codes billable?

 

[csperoni]

Exactly as @Orthocoderpgu states. 76830 and 93976 are NCCI edits that may be overriden with a modifier (like 59, XU, XS, etc) when appropriate. If billing these 2 codes together with a modifier, many insurances will request records to determine if it is appropriate to bill for both. A quick check of blood flow during 76830 does not necessarily make 93976 billable separately. If the records indicate 2 distinct tests, and medical necessity, for unusual situations, then I would appeal the denial with the medical records.

 

[edereje]

Which modifier would you use XU or XS for CPt code 76830 edit with 93976

 

[edereje]

Exactly as @Orthocoderpgu states. 76830 and 93976 are NCCI edits that may be overriden with a modifier (like 59, XU, XS, etc) when appropriate. If billing these 2 codes together with a modifier, many insurances will request records to determine if it is appropriate to bill for both. A quick check of blood flow during 76830 does not necessarily make 93976 billable separately. If the records indicate 2 distinct tests, and medical necessity, for unusual situations, then I would appeal the denial with the medical records.

Hi which modifier would you use XS or XU?

 

[csperoni]

Hi which modifier would you use XS or XU?

I would apply whatever modifier (IF any) is supported by the records. From my experience, many (clinicians, coders and billers) will incorrectly assign both codes when not appropriate.