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Wiki Mod 59 with DME

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iowagirl77

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Cedar Rapids, IA
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I have a few claims that were billed with DME L1902 and L4361 where BCBS and Humana denied L1902 for bundling. They were both billed with KX and a laterality modifier. We appealed, and Humana paid but BCBS still denied, stating per NCCI it is mutually exclusive. I have searched and searched but cannot find anywhere that NCCI states this. Modifier 59 is an option for L1902, but I've never added it to DME. I would imagine it was appropriate if the two items were for different limbs, but are there other instances when would it be appropriate? i.e. daytime stability vs protection while sleeping.

Thanks!
Susan
 
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