Wiki Gastroenterology modifier issue

[GLaycock]

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I have a claim which is denied for inconsistent or missing modifier, can someone give me any ideas? We billed a 43262 for Biliary obstruction and a 43274 for elevated bilirubin with a 59 modifier. Medicare paid the 43274 but is telling me that 43262 needs a modifier. Have billed it every way we can think of, HELP.

 

[cburton]

Gastroenterology modifier needed

Did you try billing with the "XS" modifier?

 

[GLaycock]

Yes, that is how we billed the first time through.

 

[lace659]

Were these done in the same session but different locations? If so, you may need to also add modifier 51 (multiple procedures) as well as modifier XS (Separate Structure) to the 43262. If the locations were the same then 43262 is not billable with 43274 per note under 43262 in CPT book - "(Do not report 43262 in conjunction with 43274 for stent placement or the 43276 for stent replacement [exchange] in the same location)".