maeliza
New
I have two radiology reports that was done for a patient that had trauma to his head and swelling around the orbital area. We billed 70480 & 70450 per the reports supports both cpt codes and we applied a 59 modifier to cpt code 70450. We always have one code that deny 70480 . Is is correct to bill these codes together and just proceed with an appeal to the insurance company or does it just depends on how the dicated report reads. Just need some feed back...
The CCI edits states that these are mutually exclusive.
Code 70480 (RVU: 9.3) and 70450 (RVU: 5.81) are mutually exclusive. You may typically only bill one of them. You may unbundle them only if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you should bill 70480 (RVU: 9.3) alone because it has a higher RVU than 70450 (RVU: 5.81). If you try to bill them together without modifier justification, code 70480 (RVU: 9.3) is at risk. Medicare will reimburse for 70450 (RVU: 5.81) at the lower RVU instead.
Thanks,
Maeliza
The CCI edits states that these are mutually exclusive.
Code 70480 (RVU: 9.3) and 70450 (RVU: 5.81) are mutually exclusive. You may typically only bill one of them. You may unbundle them only if you can justify the use of an appropriate modifier. If you are unable to justify the use of a modifier, you should bill 70480 (RVU: 9.3) alone because it has a higher RVU than 70450 (RVU: 5.81). If you try to bill them together without modifier justification, code 70480 (RVU: 9.3) is at risk. Medicare will reimburse for 70450 (RVU: 5.81) at the lower RVU instead.
Thanks,
Maeliza