Question Need Help - CPT code 93623 denial for using Modifier 26, by IEHP

vidraj

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Buffalo Grove, IL
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Hello everyone,
Has anyone going through the same issue that IEHP has been denying code 93623, stating - "Procedure modifier 26 was invalid on the date of service" and to submit with a different Modifier?
This is for Cardiology provider at California.
When checking with Codify, it doesn't suggest any edits.
Can we use Modifier 59?
Thank you in advance.
 

Jim Pawloski

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Was 93623 performed after an ablation? If so, it is bundled into the ablation code. If it was done before the ablation, then try modifier -59.

HTH,
Jim Pawloski, CIRCC
 

vidraj

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Hi Jim,
Appreciate your response.
Yes, it was done post ablation to check if Ablation worked and any persistent Arrhythmia.
While checking with codify, it doesn't show up as bundled. Where am I going wrong?
 

Jim Pawloski

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I don't use Codify, so I can't help you there. In Z-health, it says DO NOT code 93623 for post ablation infusion to check the efficacy of the ablation.
 

rblundell

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La Mesa, CA
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Hello everyone,
Has anyone going through the same issue that IEHP has been denying code 93623, stating - "Procedure modifier 26 was invalid on the date of service" and to submit with a different Modifier?
This is for Cardiology provider at California.
When checking with Codify, it doesn't suggest any edits.
Can we use Modifier 59?
Thank you in advance.
Were you able to get this resolved? I am running into the same issue with Molina in California, modifier 26 was denied as "missing or invalid modifier" I called and the rep stated a note showed modifier 26 was inappropriate. I then removed and billed with no modifier and got a "required modifier missing" denial.
 

vidraj

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Buffalo Grove, IL
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No . We explained our physician after Jim's response that this is bundled when done with Ablation and that only IEHP is not paying , so we adjust the payments.

If anyone has any updates on the same , please do suggest. It will be helpful!
 
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