Wiki cystoscopy and incision modifier needed?


Lakeville, IN
Best answers
We have a Dr billing a 52281(cystoscopy and treatment) and 53020(incision of urethra) together to medicare. They have paid on the 52281 but keep denying the 53020. I am wondering if a modifier is needed and if so which modifier should be used? We have tried no modifier and recieved a denial and also tried a 59 modifier on the 53020(incision of urethra) and they denied that as well.

53020 is a column 2 code to 52281. You can't bill them together under any circumstance. You can only bill 52281. Hope this helps.

Machelle Freeman, CPC
Falls under the "separate procedure" designation under NCCI which is bundled into the primary procedure. Making the hole bigger to insert the scope is not separately reportable. Automatically adding modifier 59 just to bypass a NCCI edit is an abusive billing practice. This seems to be misreported enough that they made it a indicator of 0 to stop modifiers from bypassing this specific edit.
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