Multi Procedure Confusion

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This is through UHC and I only have 2 cpt codes, who knew I would be so confused?!?!

1st claim I submit:
67904-50 (Procedure - Ptosis Repair; Dx - H02.413 Mechanical Ptosis bilateral upper eyelids)
67924-51; E4 (Procedure - Entropion Repair; Dx - H02.032 Senile Entropion right lower eyelid)

I thought since the first procedure was for upper eyelids and the 2nd procedure was for the lower eyelid, that's all I needed, even though the two codes are bundled, they weren't performed on the same eyelid.

However, UHC denied the claim stating procedure 67904 is not paid separately. We only received payment for 67924.

So, I tried again w/corrected claim and reconsideration request form:
67904-XS; 50
67924-51; E4

And again, the claim denied payment for 67904. I received a letter stating they processed the claim accurately. No further payment is due. Reimbursement policy CCI Editing Policy was used to process this claim. I called UHC for help, but was told they can't help me with this.

Any help would be greatly appreciated!
 

Quinnies

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12
Location
San Antonio, TX
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2 things 1. Because they are bundled but you didnt indicate that is a different procedure. you indicated that it was multiple procedures. You should have reported with modifier -59 if substantiated in the Report. 2. It may still deny at that point I would send report because both codes pertain to the Tarso the report may be needed to substantiate 2 different incisions.

Crystal
 

Quinnies

Contributor
Messages
12
Location
San Antonio, TX
Best answers
0
2 things 1. Because they are bundled but you didnt indicate that is a different procedure. you indicated that it was multiple procedures. You should have reported with modifier -59 if substantiated in the Report. 2. It may still deny at that point I would send report because both codes pertain to the Tarso the report may be needed to substantiate 2 different incisions.

Crystal
 
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