Need help. Billing 10160 with 20610?

Madcoder

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1st submission:

10160 (25)
20610
J1040

20610 and J1040 were paid.

Resubbed:

10160
20610 (51)
J1040

Still denying 10160. Payment included with other procedure.
The physician drained a hematoma on LT shin and gave cortizone injection in RT shoulder.
What am I missing?
 

dclark7

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First submission is incorrect because 25 does not go on any procedure codes, only E/M codes. Second submission should have used 59 instead of 51, since these codes ae bundled under NCCI edits the only way to unbundle them is with a 59 modifier. Also make sure you are linking the correct diagnosis codes to the correct procedure.
 
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Need to see documentation

You would use the -59 modifier ONLY if 10160 was truly separate from 20610.

Without seeing the full documentation, I cannot tell you whether it is appropriate to use any modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

dclark7

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The information Madcoder provided states that a left shin hematoma was drained and a right shoulder cortisone injection was given. Two totally different body areas which would make them separate procedures. So, based on the information provided modifier 59 would apply, which is also why the diagnosis codes need to be linked correctly.
 
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