Wiki PA Medicaid Modifiers LM,RI,LD,RC,LC on CABG Procedures

[GJackson]

Does anyone have experience with using these modifiers?

I Need Help with the Following Procedure codes were denied because we need to add the correct modifiers and I am lost?

We billed a 33533 and a 33517. Coronary Artery bypass graft x1 single saphenous vein bypass graft from aorta to circumflex marginal #2 coronary artery.

I am thinking the 33517 gets an LC- Lt circumflex coronary artery. I have no idea what they are wanting on the 33533

All help is appreciated. My note is in a pdf and i can't copy the note to paste it. Sorry.

 

[markford]

The first thing I would do is check the claim on the Promise website. The reasons for denial at the bottom of the claim are often more descriptive than what show on the EOB. The second thing I would do is make sure you've got the correct PSR/AUTH, sometimes that is what they are looking for with the denial statement you have. Since the CABG CPT codes are for the number of anastomoses done, it would be difficult to accurately use modifiers, and sometimes PA Medicaid claims don't always accept modifiers. Good Luck!