Wiki coding denial v2790 as incidental to 65778

[JudyBoring]

Would this be payable with a modifier 59 thru BCBS along with documentation? Previously denied incidental (NCCI)

 

[CodingKing]

What the place of service, are you working for the physician or facility? Physician RVU includes the supply thus not separately billable.

 

[JudyBoring]

place of service 11, Physician charges

 

[CodingKing]

Its accounted for the practice expense portion of the Office RVU.

Facility is RVU of 1.61 (locally adjusted for CO) and Office based RVU is 40.91 (locally adjusted for CO) to account for the physician supplying it

(click thumbnail for RVU breakdown)

 

[thomas7331]

I agree, reimbursement for V2790 is included in the allowed amount for 65778 and should not be reported separately. I would add that per NCCI, V2790 always bundles to 65778 and can't be bypassed with a modifier.

 

[JudyBoring]

They are also practicing and performing in a surgery center...does that allow them to bill under a different pos? Would it be payable then?

 

[CodingKing]

They are also practicing and performing in a surgery center...does that allow them to bill under a different pos? Would it be payable then?

Surgery center would bill for the V code as its a facility expense for ASC. Physician would not be able to bill for it. Reimbursement for the 65778 would also be reduced in ASC since the implant is no longer a physician expense.