Medicare denial - Now Medicare paid but not for

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This is what was billed:
93454-26-22
93306-26-59
99223-25-AQ
Now Medicare paid but not for the 93454 stating inappropriate place of service and I was told this service can not b done as inpatient. What am I missing. I see nothing in the CPT book or in the LCD that say it can not be done there. Is there a modifier I am missing or do I need to take off the 22? Thanks Nancy
 

rykin7609

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Local Chapter Officer
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Alvin, TX
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hope this helps

Nancy,

Sometimes their reasons for a denial drive me crazy. I have learned never to totally trust their reasons.

As for the three codes, I am wondering why 93306-26 has a modifier 59 adjacent to it? I just looked through the Edits and do not see where 93306 would need a 59. I have found that sometimes simple denials such as this make me scratch my head. I believe the modifier 59 is what your problem is.
I personally have never posted a 93306-26 with a modifier 59 along with a cath procedure and E&M.



"This is what was billed:
93454-26-22
93306-26-59
99223-25-AQ
Now Medicare paid but not for the 93454 stating inappropriate place of service and I was told this service can not b done as inpatient. What am I missing. I see nothing in the CPT book or in the LCD that say it can not be done there. Is there a modifier I am missing or do I need to take off the 22? Thanks Nancy "
 
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