Wiki codes 10061 and 20605

[skylerstigger]

A pt came in and had the following procedures done, I posted them as such 10061 and 20605-59 along with office visit with -25 on it. Medicare came back and paid on all but the 10061, when the biller called medicare she was told that modifier -59 should have been put on the 10061. Can someone tell me which is the correct way to bill this? I am confussed because I was taught one way while I was in school and now medicare is telling me that is wrong. Please help.

 

[SallieF]

Medicare usually allows code 10061 with modifier 59 as long as it is a separate location. If it is the same area it is bundled.
Hope this helps.

 

[skylerstigger]

But which of the procedures should be listed first. 10061 or 20605? 20605 costs less than 10061

 

[mitchellde]

Regardless of the charges, when dealing with a component of comprehensive edit, the modifier always goes on the procedure designated as the component.

 

[RebeccaWoodward*]

Although 10061 has more RVU's than 20605...10061 bundles into 20605 per CCI edits..So according to edits...10061 would receive 59 IF both are performed at separate locations, same session.


http://www.cms.hhs.gov/NationalCorr...r=ascending&itemID=CMS046397&intNumPerPage=10