Wiki IV Lido Billing CPT CODES correct?

[nathan.binion21@yahoo.com]

Hello, I am trying to figure out alot of denials I am having for our IV lido procedures for pain management. Currently we are billing 96365+ j2003-50 units+93040+94761. The practice I've joined has been billing these codes for years and I just wanted to check if this would be correct for billing. The denials usually deny the 96365 and pay for the 93040. I think it may be 93040 +94761 is bundled with 96365. Working the denials is new for me, please let me know if you have any ideas or info. Not sure if MOD 59 would be appropriate.Thanks!

 

[Troykall1]

You cannot bill CPT codes 96365+J2003+93040+94761 together because 93040 is a procedure code and 96365 and 94761 are services performed during the same session, which likely would not be separately reimbursed. CPT 93040 is also not an appropriate service to be provided in conjunction with IV infusion or pulse oximetry. Additionally, the medication J2003 is a specific substance administered via IV infusion, not a service rendered, and it's not appropriate to bill the medication and procedure separately in this manner. You may need to use modifier 59 if appropriate and only bill for services that are not bundled or overlapping. The specific modifier 59 should depend on the circumstances and what is considered medically necessary. For example, use of modifier 59 may be appropriate, but only if the services are truly separate and distinct. I hope this helps.