Wiki PICC line insertion

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tmorehart

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I am coding a 36569 and 76937 for a picc line insertion. This procedure was done twice in one day due to it accidently being pulled out. We billed the second one with mod 36569-76 and 76937-76 and Medicare is denying the 36569-76 due to invalid modifier. Can anyone tell me how I should be coding this?

Thank you in advance for your help!
 
due to the fact the line was accidentally pulled out you should bill it with modifier 59 instead of modifier 76. Modifier 59 will define the distinct procedure due to the nature for the repeat. I believe it would be best to appeal with proper documentation as well.

Good luck!
 
claning said:
how about a modifier 59? seperate sessions would be distinct services...carol
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Hi
yes. seperate sessions would be the distinct services, you are suppossed to append the modifier 59, those are the two or more procedures sud not be payable together.

for example: pateint came to hospital emergency dept. on morning 10 0 clock, and taken the chest x-ray and vein puncture for blood, and when the patient was returning to home, met with an accident and severe head injury happend, and taken to the same hospital emergency room and entered the critical care for 1hr.

it is supposed to code as 99291 and 710x0-59 and 36415-59. b,cos the hospital or physician submitted the both sessions services in a single claim to the payer.

but in another scenario the chest x ray and vein puncture are not seperately payable and included in critical when done with it. but done at different session. but record must be documented and supported to append mod-59. if document doesnt support the criteria , it is not supposed to code. only critical care service sud be coded
 
tmorehart said:
I am coding a 36569 and 76937 for a picc line insertion. This procedure was done twice in one day due to it accidently being pulled out. We billed the second one with mod 36569-76 and 76937-76 and Medicare is denying the 36569-76 due to invalid modifier. Can anyone tell me how I should be coding this?

Thank you in advance for your help!
Click to expand...

I am in agreement with your selection of modifiers. It was a repeated procedure. Perhaps your diagnosis code needs some work. Or you can appeal with documentation. I disagree with the 59. since this is a repeated procedure in a different session the 76 will allow a bypass of the discounting which is allowable in this circumstance.
 
hi
actually the failed procedures should not have been billed, since the first picc line was accidentally pulled out dt was mistake done by physician, sud not be paid, only once it will be paid. and if we go for ultrasound guidance 76937, it was repeated for the purpose of picc line again, so it would be paid 76937-76, but picc line procedure second time would not be paid.


thank you.
 
jai prakash said:
hi
actually the failed procedures should not have been billed, since the first picc line was accidentally pulled out dt was mistake done by physician, sud not be paid, only once it will be paid. and if we go for ultrasound guidance 76937, it was repeated for the purpose of picc line again, so it would be paid 76937-76, but picc line procedure second time would not be paid.


thank you.
Click to expand...

The original poster did not state this was pulled out by the physician as in a mistake by provider. It was reinserted in a different session according to the post. I assumed the patient mistakenly pulled it out. At any rate if the procedure were repeated in a different session it can be billed again.
 
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