Wiki Help Please! DBS subsequent programming

[stacymoch]

Neurology office with DBS subsequent programming claim problems.
Provider spent total of 74 minutes of programming, with an E/M office visit and exam. Do I need to add a modifier to the "add-on" code for the additional 14 minutes?
Claim currently reads:
99214-24
95978
95979
Payer is stating that 95978 needs modifier 52 added for the reduced service???
Why doesn't this make sense to me? 95978 is for the first hour, which was accomplished. 95979 is for each additional 30 minutes. If a modifier is needed wouldn't it be added to the 95979?
Feeling frustrated in Oregon today........

Stacy Moch, CPC-A (only one month to go to remove the 'A' )

 

[pclaybaugh]

Reduced services doesn't make sense. I would appeal.

 

[marvelh]

95979 is for each additional 30 minutes after first hour. Wouldn't you need to have at least 76 minutes of total programming time to bill the add-on code - 60 minutes for the parent code & 16 minutes for the add-on code?

Since these are time based codes, the time must exceed the mid-point in order to bill.

The use of modifier 52 is not applicable for the add-on code, only the parent code - For 95972, 95974, and 95978, use modifier 52 if less than 31 minutes in duration.