Wiki Codes 23930 and 23931

[hockeychic]

We billed these two codes together with a 51 modifier on code 23931. The insurance company paid this code but denied 23930 as incidental. Code 23930has the highest RVU and they are mutually exclusive, so we feel it should be paid as the primary procedure. We appealed the denial and they are upholding their decision. Any thoughts as to whether we should try a second level appeal for this?

 

[josephmglick]

There is a CCI edit in place so a 51 modifier will not override that edit. A 59 modifier would be needed if documentation supports billing of both codes.