old cath code question

manda12

Networker
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41
Location
Orange Park Florida
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hello,

last year when we had a stent along with a cath we had to bill a -59 modifier with the cath and S&I codes. we never put it on the injection code 93545. however, we have some from last yr that United healtcare has denied the 93545 stating it cannot be seperately reportable.has anyone else have this issue? should we put a -59 on this procedure even though according to the CCI edits it doesnt state that we need it. if you can help in anyway that would be greatly appreciated. thanks!
 

bkiesecker

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grand canyon(PHX)
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i have seen this with united health care as well i would call them and explain to them that it is not bundled and maybe send documuntation that it is distinctly diagnostic and then therapeutic (plus CCI)

you should be able to get it payed. I am not sure why this happens with united

hope that helps
id be interested on others expereinces as well
 

Jess1125

Expert
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Green Bay
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Yes, I have the same experience with United Healthcare. They are the ONE insurance company that wants the -59 on the 93545 as well. I put it on (even though I know it isn't needed...)

Jessica CPC, CCC
 
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