Wiki Procedure Reimbursement Not Paid Separately

[sammartin92472]

I'm new to all of this and I'm trying to follow-up on a few unpaid claims. I've run across this one which is for BCBS the CPT is 97762. The claim has been denied with the denial code of "Procedure Reimbursement Not Paid Separately". What does this mean? Does it mean this is a code that has to be billed with another code to be reimbursed?

 

[CodingKing]

They are likley bundling it with the reimbursement of the orthotic

 

[honeybee]

You probably need to apply the 59 modifier to the code in order to get it paid but it really depends on what other codes are being billed on your claim as to whether this is true or even appropriate.

 

[hopepg]

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Review CCI edits on the CMS website. Read through how to use the reports for "column 1/column 2" codes. It all looks very confusing but once you learn how to look up the relationship codes in these reports, it all becomes very straightforward.

Never add modifier 59 to a code unless the report/dictation supports separate billing of that code. Blindly adding modifier 59 to claims can open your provider up to payer audits.