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Help Medicare Saying incons codes

Rip

Networker
Messages
53
Best answers
0
I'm new to this...2 months on the job.
So I have a lot of questions.

Dr. performed
67904
14060
67917

Patient somehow did something to require Dr. to repeat procedures.
I sumitted the 2nd encounter as:
67904 - 76
14060-51-76
67917-51-76
And Medicare is saying
C04-Code inconsistent with Mod.

I've checked code correct and all procedures list those modifiers as ok.

Help.
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
the 76 would be the first listed modifier and most Medicare FIs no longer want the 51. Also what is your dx code for the second encounter? what was the reason for needing to repeat.
 

Rip

Networker
Messages
53
Best answers
0
I believe it is the same diagnosis as the iniitial encounter.
But the patient was wearing some sort of prothetic that affected the surgery about 1 week after
the initial surgery
and Dr. felt he needed to repair so it would heal correctly.
 
Last edited:

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
it does not sound like the same dx to me. could be a complication but it will depend on the documentation. also it will change the modifier from the 76 to the 78 for each procedure.
 

Rip

Networker
Messages
53
Best answers
0
The complication is due to a poorly fitting nasal prothesis.
Patient did acquire a new and better fitting prosthese which is not causing
any traction or pressure on the left lower eyelid.....

Any suggestions on a complication dx?
I can only find internal prosthiesis codes...........................
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
You may need a code for complication of other prothetic and possibly a fitting and adjustment of device V code. Was there truely a complication or just discomfort necessitating a refit, that would be a code from either the V52 or V54 category and no other dx necessary. If there was a complication which needed attention as well as a new prosthesis then code a complication as well as the V code for the fitting and adjustment.
 
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