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Question on fluorscopic guid & location

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We have been billing Health America/Coventry for the professional component for 62311 and 77003 because they do not accept 1500's. They are rejecting with comment: inappropriately coded, submit with appropriate code.

Here is how we have it coded:
12/15/11 $20.00
12/15/11 77003 26 $87.75
12/15/11 62311 $1,221.75
12/15/11 76101 $594.25
12/15/11 62311 26 $236.25
12/15/11 J1040 $33.25

Any suggestions on what we are doing wrong would be greatly appreciated. Thank you. Sue LaHood CPC-A
 

OCD_coder

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Nashville AAPC Chapter
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My question is why are you coding a 62311 twice and why do you have a mod-26 on the second procedure?
Mod-26 is for procedures with a professional and technical component such as radiology.

Also, if you have a mod-26 on one radiology code, why not all of the others. Is this procedure being done at a facility? or an office type procedure room?

Without seeing the Procedure note and knowing where the procedure is taking place, it's a little hard to tell you where all of your errors are. I am curious to the 76101 and why you are billing for the drug as we do this procedure at a local ASC and do not bill either of these with the 62311/77003-26 code combo. The parenthetical states do not bill more than once.
 
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I was told that one 62311 is for the technical aspect and the other for the professional, thus the 26 on one. This insurance company won't accept profee's from us so we have to bill all on the UB. I didn't code this it came back from insurance as a rejection and we are trying to determine the correct coding.

It was done as outpatient at the hospital surgical center.
RF FLUORO PAIN FOR INJ PARA FACET:
The patient has had lumbar epidural steroid injection for radiculopathy, L3-L4 and is back for a repeat procedure. No films were obtained.

Does any of this make this clearer?
Thanks!
Sue
 

kevbshields

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Louisville, KY
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If you're billing for both the hospital and physician (which is what I am sensing), then your revenue codes would map back to the line item that represents facility and the line item that represents physician. If, in fact, you are combining both 1500 and UB charges on the UB, you would need a separate line item for professional and "technical" (institutional) charges. However, your modifier 26 on 62311 is inappropriate. Your revenue code will show that it is a professional service, no need to do so with a modifier on the UB.

Your "professional service" fluoro is probably bundling into the 62311.
 
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