Wiki Repeat Procedure

[cupofjava79@yahoo.com]

Good evening, everyone! A puncture aspiration (10120) was done x2 because the abscess was on the shoulder & also the stomach. I wanted to code 10160, 10160-76, but management said to just bill it with x2 units on the CMS. The insurance ended up denying 10160 x2. No one knows how to code this, or even if a modifier is required. Does anyone have suggestions? Thank you so much in advance! I appreciate this forum and a community of fellow coders willing to help each other out.

 

[thomas7331]

Good evening, everyone! A puncture aspiration (10120) was done x2 because the abscess was on the shoulder & also the stomach. I wanted to code 10160, 10160-76, but management said to just bill it with x2 units on the CMS. The insurance ended up denying 10160 x2. No one knows how to code this, or even if a modifier is required. Does anyone have suggestions? Thank you so much in advance! I appreciate this forum and a community of fellow coders willing to help each other out.

Your management gave you incorrect information, as CMS does not allow multiple units on surgical CPT codes unless they are add-on codes. You'll need to report these two procedures on separate lines.

A procedure performed on a different anatomical site isn't a repeated procedure, it's a separate and distinct procedure that just happens to be reported with the same code. So, I would not use modifier 76, I would use modifier 59 or XS for the second procedure.

 

[cupofjava79@yahoo.com]

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Your management gave you incorrect information, as CMS does not allow multiple units on surgical CPT codes unless they are add-on codes. You'll need to report these two procedures on separate lines.

A procedure performed on a different anatomical site isn't a repeated procedure, it's a separate and distinct procedure that just happens to be reported with the same code. So, I would not use modifier 76, I would use modifier 59 or XS for the second procedure.

I had forgotten about XS. Thank you for your input!