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Wiki Modifier Help!

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hbarney1

Networker
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Hi,

so I received a claim with 75625 and 75716 wanting those appended with a modifier. I am looking at the NCCI edits and they had a 1 by them. When I go to the claim I am still unable to append any modifier. Is this because they are bundled? These codes were denying with HCPCS C9600. I have looked online and unable to see a website with guidelines on these codes. Cardiology isn't my strong suite when it comes to coding. Any help will be appreciated. :)
 
Hard to know what's going on without an op report but here's my 2 cents

Are you coding for the facility or the physician?

C9600 is the facility charge for a drug eluding stent placed in a coronary artery. Physician charge is typically 92928 or 92941.

75625 or 75716 would not typically be billed with a stent placed in a coronary artery.
 
espressoguy said:
Hard to know what's going on without an op report but here's my 2 cents

Are you coding for the facility or the physician?

C9600 is the facility charge for a drug eluding stent placed in a coronary artery. Physician charge is typically 92928 or 92941.

75625 or 75716 would not typically be billed with a stent placed in a coronary artery.
Click to expand...

I agree with Mark!
 
hbarney1 said:
Hi,

so I received a claim with 75625 and 75716 wanting those appended with a modifier. I am looking at the NCCI edits and they had a 1 by them. When I go to the claim I am still unable to append any modifier. Is this because they are bundled? These codes were denying with HCPCS C9600. I have looked online and unable to see a website with guidelines on these codes. Cardiology isn't my strong suite when it comes to coding. Any help will be appreciated. :)
Click to expand...

I hope you have a vessel modifier with C9600 drug eluting stent placement. You will need three modifier -59 attached to codes. First one is to the heart cath if it was a diagnostic cath and the patient didn't have one previously. The second and third modifier -59 is attached to 75625 and 75716 to show that they are separate and distinct procedures performed.

This may help you get past the NCII edit.

Jim Pawloski, CIRCC
 
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