Wiki Neuropsych testing

[abyrne]

We have a provider who performed testing the same day as the tech did. I know that 96138 can be reported with 59 modifier in this case since it would be bundled with 96136. However there is no NCCI edit for 96139 with 96136 so is it appropriate to append 59 to 96139? Insurance is denying 96139 as bundled (it's not bundled with any other services billed per NCCI edits).
It's my understanding that modifier 59 is only used if the code pair is on the NCCI edits, or if it’s the same cpt but different site, etc. Therefore it would not be appropriate to use 59 on CPT 96139, correct?

 

[shanamarie]

We are having the same issue. I’ve been told by medica that they are having issues with their system not processing add on codes correctly and so they have said they are reprocessing all of those. I have tried to add a modifier to 96139 and some payors have processed it that way, but I agree that it shouldn’t be needed. I’m not sure what the next step is, maybe appeal with notes? Let me know if you figure it out!