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National Government Services (NGS) Global Denial 2014 Stent Code

cdemario

Contributor
Messages
10
Best answers
0
Has anyone been experiencing denials on new 2014 stent codes (37236/37238) when submitted with global modifier 78? CMS shows that this code has a 000 global period so modifier is needed, however when -78 modifier is appended, it is denying for "inconsistent modifier". Follow up calls show that NGS won't accept the -78 but will the -79 (which makes no sense since they are both global modifiers). Has anyone had success appealing?
Thank you!
 

marytwalsh

Networker
Messages
52
Location
Haverhill MA
Best answers
0
NGS denials

I work at 2 different offices 2 different specialties ..Since Oct 2013 when the NGS contractor was hired by Medicare we have had so many claims denied.

Now I go on to: 1) NGSMedicare website// 2) select Jurisdiction // then to left select Medical Policy Center (MPC) // 3) Here you can enter the CPT code in the searchbox: SEARCH FOR LOCAL MEDICAL POLICY INFORMATION then read all but concentrate when you get to: INDICATIONS and all info after - All of the LCDs i have researched provide the accepted ICD and CPTs and {also list the NOT accepted ICD and CPT
I have had to meet with my doctors to go over all of the NGS info so that they can make informed decisions on their documentation, diag and cpt decisions.

OF NOTE: when you entered #3) (above) There are at least 4 blue striped topic sections that might help your search
 
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