Wiki ENT Coding Issue

[rableashlyn14@gmail.com]

Hello,

I work for an ASC and code for the facility side, I currently have a claim that has been denied over and over again, it is an Anthem claim. I keep getting a B15 denial (and they are asking for a qualifying procedure to be utilized), here is what I have tried:

I originally coded 69436-50, 69424-59-50, & 69706

1st denial: I took off off the second line (69424-59-50) and added a modifier 59 to that third line, so the claim now reads: 69436-50 & 69706-59

2nd denial: I switched code 69706 to be in the first line and 69436-59-50 to be the second line.

Denied again.

I am currently at a loss on what they may want, does anyone have suggestions?

 

[Shana DuBois CPC]

I do not know if it helps or not, but I was told that
ASC billing does not accept modifier 50... so it would be 69436-rt, 69436-LT & 69706-59

 

[MH3550]

69706 is a device dependent procedure code. Do you have C1726 billed for the balloon catheter? I'm not as familiar with ASC rules but the device may still need billed.

 

[rableashlyn14@gmail.com]

69706 is a device dependent procedure code. Do you have C1726 billed for the balloon catheter? I'm not as familiar with ASC rules but the device may still need billed.

This was the answer! Anthem accepted it this morning, strange as I ran a CPT report and Anthem seems to be the only one who likes this HCPCS code on their claims w/ these other procedures, but thank you so much!