Wiki Removal of Fallopian tube

[Sheyla44]

Please help!

Patient presented at the office with right tubal ectopic pregnancy and Rhogam. Billed 99203, 96372 and J2790, POS: 11.

Patient was sent to the hospital, same date of service- billed 58700 POS: 22.

Medicaid denied 58700 due to "conflict billing rule" NDCC guidelines. Previous payment provided with 96372.
Not sure if this makes sense. Could someone please advise?

Thank you so much!

 

[csperoni]

1) 58700 performed for ectopic is incorrect. Correct code should be 59120 [Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach].
2) Modifiers -
99203 I would add -57
96372 possibly -59 if warranted
59120 -XE (if your state Medicaid accepts it)
Now, if you carrier wanted to include 96372 in visit, or bundle with surgery, I might not necessarily agree, but could accept that.
Stating your surgery payment is included in the injection is absurd.
Hope this helps!

 

[Sheyla44]

1) 58700 performed for ectopic is incorrect. Correct code should be 59120 [Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach].
2) Modifiers -
99203 I would add -57
96372 possibly -59 if warranted
59120 -XE (if your state Medicaid accepts it)
Now, if you carrier wanted to include 96372 in visit, or bundle with surgery, I might not necessarily agree, but could accept that.
Stating your surgery payment is included in the injection is absurd.
Hope this helps!

Thank you so much for your help!