Help with a global denial for cpt 93290

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Hi

CTCR MCR is denying in person device evaluation (93290) as global to the remote evaluation (93295) because it was performed within the 90-day period. Would a modifier be needed in this circumstance? I was thinking modifier -58? I am new to cardiology coding and could use some assistance. Thank you so much
 

jewlz0879

True Blue
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I wouldn't use -58 unless this was a staged or related procedure/svc by same physician during PostOP period. I don't know the circumstances or history of this patient but I don't think 58 would be appropriate.

Per NCCI, you do need a modidier in order to bill 93290/93295 together; I would use 59 if the documentation supported such.

HTH
 
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The procedures were performed on different dates. 93295 was performed in January. 93290 was performed in March. The insurance is denying 93290 inclusive to the global period of 93295.

Thank you for your response
 
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vlarson

New
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Windsor Locks, CT
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The procedures were performed on different dates. 93295 was performed in January. 93290 was performed in March. The insurance is denying 93290 inclusive to the global period of 93295.

Thank you for your response

We had this happen as well with ConnectiCare patients. Did you end up winning the fight? I have one now for Anthem BCBS
 

scuatro4

Networker
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• Reported no more than once every 90 days (and not to be reported if the monitoring period is less than 30 days)
• A period is established by the initiation of the remote monitoring on the 91st day of a pacemaker or ICD monitoring and extends for the subsequent 90 days for Which remote monitoring is occurring
• A service center may report pacemaker and ICD remote data acquisition during a period in which a physician performs an inperson interrogation device evaluation, but a physician may not report and in-person and remote interrogation of the same device during the same period
• When an in-person interrogation device evaluation is performed during a period of remote interrogations device evaluation, only remote services may be reported
• May be reported in addition to programming device evaluations during the remote interrogation device evaluation period
 
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