I have a patient who had a hip replacement due to arthritis. Coding for the CRNA services, I used CPT 01214 with dx M1612. Later the same day, the patient dislocated the new hip and was taken back to the OR for revision. I billed a second case with CPT 01215 with dx T84021A. The 01215 denied by Medicare, and the biller sent in documentation detailing the two separate cases. Medicare came back and denied again stating the claim was originally processed correctly and therefore they will not be making an adjustment due to "code 01214 (column 1) has a CCI conflict with code 01215 (column 2). A modifier is not allowed to override this relationship."
I was thinking about using mod 59 on the 01215, but it looks like Medicare is saying I cannot?
I was thinking about using mod 59 on the 01215, but it looks like Medicare is saying I cannot?