Wiki Modifier LD - applicable with this procedure

[coders_rock!]

Hello,

The insurance carrier is denying CPT code 92928 because modifier LD was used. I am somewhat confused because I thought this modifier was applicable with this procedure. Can someone please help? I cannot find any information stating that it should not be used.

Thank you in advance.

 

[Jim Pawloski]

Hello,

The insurance carrier is denying CPT code 92928 because modifier LD was used. I am somewhat confused because I thought this modifier was applicable with this procedure. Can someone please help? I cannot find any information stating that it should not be used.

Thank you in advance.

I would ask the carrier why the refusal. That's the way I would code it. If you can, can you post the report.
Thanks,
Jim Pawloski, CIRCC

 

[mdm58]

LC RC LD modifiers

We are getting the same denials and have been told that the modifier is invalid for this code, and they can not tell us how to bill!!! We are just appealing the claims. I have no idea what the problem could be!!

 

[Summer]

Modifier LM and RI

Hi all,
Those of us in Florida are also receiving denials for the usage of modifier LM and RI.

Our MAC did post this Dec 28, 2012:

One time notice from Medicare:

I. SUMMARY OF CHANGES: Additional modifiers shall be added to the list of NCCI-associated modifiers that will allow an edit with modifier indicator of “1” to be bypassed when the modifier is utilized correctly. These modifiers are LM (left main coronary artery), RI (ramus intermedius), 24 (unrelated evaluation and management service by the same physician during a postoperative period), and 57 (decision for surgery).

Each NCCI edit has a modifier indicator of 0, 1, or 9.A modifier indicator of 0 indicates that an edit should never be bypassed even if an NCCI-associated modifier is utilized on the claim.That is, the column two code of the edit must be denied.A modifier indicator of 1 indicates that an edit may be bypassed if an appropriate NCCI-associated modifier is appended to the column one and/or column two code on an NCCI edit.That is, the column two code of the edit may be paid if an NCCI-associated modifier is appended to an appropriate code of the edit pair.A modifier indicator of 9 is assigned as a placeholder for edits that have been deleted.

The current NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, RC, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, 25, 27, 58, 59, 78, 79, and 91.

Additional modifiers shall be added to the above list of NCCI-associated modifiers that will allow an edit with modifier indicator of “1” to be bypassed when the modifier is utilized correctly. These modifiers are LM (left main coronary artery), RI (ramus intermedius coronary artery), 24 (unrelated evaluation and management service by the same physician during a postoperative period), and 57 (decision for surgery). Refer to Attachment A (Medicare Claims Processing Manual, Pub. 100.04, Chapter 23, Section 20.9.1 and 20.9.1.1) will be updated in the near future to include these new NCCI asociated modifiers