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Wiki Medicare denials for 20611 with modifier -79

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nicole@priorityonebilling.com

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Hello!

I need help with multiple Medicare denials with remark N823 Incomplete/invalid/procedure modifier when billing 20611-79-RT or 20611-79-LT during a global period. Example: The patient is in global period for RT knee surgery and they receive a 20611 injection to the left hip. Therefore, the 20611 is unrelated to the surgery. But, Medicare (Florida) is denying the 20611 with remark N823. I don't understand why? I checked the Medicare portal and confirmed the issue is not hospice related and the need for a GW modifier. Any help is appreciated.
 
All of their links advise the 79 should be appended.

These would be some of my questions:
Was there anything else billed on the same date as the 20611?
Are the ICD-10s correct laterality-wise and match the laterality modifier?
What does the whole claim have on it?
Are they definitely still in the global for the prior procedure?
Is it every single time this scenario is billed? When did it start? How many claims are you talking when you say "multiple".
Is it definitely due to the 79 and not the laterality conflicting with the dx code? Because you could get that denial remark if you have a LT/RT issue.
 
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