Wiki Central Line Placement

[rachelfox]

Our provider performed a central line tunneled placement and has been trying to get Medicare to pay for 36558. They denied the service as bundled to another procedure. We also billed 99233/25 and 76937. We recently found out that another provider's office that we do not bill for billed a 36556 two days after we did. Would their office have to bill with a modifier? If so, would a 77 be appropriate or not since it was not the exact same procedure?

Rachel Fox, CPC

 

[dcarrier1021]

You are correct with your code, the othter office needs to append their claim and add modifier 77.

 

[lizard]

could be that this is a separate event from your Dr's. 36558 is tunneled and 36556 is non tunneled. My doc does these a lot and sometimes the patient has trouble with one and they have to do another. I don't know that the modifier 77 for the other Dr. is really correct because it is not really a repeat procedure. I think there is something else causing this denial. was anything else done by your physician or a physician in your group prior to this?