Wiki Reporting 73140 and 73130

[t_k_hott@yahoo.com]

Hello,

I have tried reporting 73140 and 73130 together, 1st without modifiers, 2nd time with modifier 59 on 73140, 3rd time with modifier XU on 73140. The 73140 keeps getting rejected. I am not sure what other modifiers I should report to get paid for 73140. Please help! Thanks!

 

[sls314]

Hello,

I have tried reporting 73140 and 73130 together, 1st without modifiers, 2nd time with modifier 59 on 73140, 3rd time with modifier XU on 73140. The 73140 keeps getting rejected. I am not sure what other modifiers I should report to get paid for 73140. Please help! Thanks!

A modifier 59 would not be appropriate for that code pair.

Here's an excerpt from the NCCI Coding Policy Manual (page 17): https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-1.pdf

From an NCCI program perspective, the definition of different anatomic sites includes different organs, different anatomic regions, or different lesions in the same organ. It does not include treatment of contiguous structures in the same organ or anatomic region


The NCCI Procedure-to-Procedure (PTP) edits do show that a modifier can be used to override the edit for 73140 and 73130. For example, it would be appropriate to use the LT/RT modifiers to override the edits to indicate that the finger and hand x-rays were done on different hands.

However, if they were performed during the same encounter on the same contiguous structure (finger and hands), a modifier isn't appropriate to use.

 

[t_k_hott@yahoo.com]

A modifier 59 would not be appropriate for that code pair.

Here's an excerpt from the NCCI Coding Policy Manual (page 17): https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-1.pdf

From an NCCI program perspective, the definition of different anatomic sites includes different organs, different anatomic regions, or different lesions in the same organ. It does not include treatment of contiguous structures in the same organ or anatomic region


The NCCI Procedure-to-Procedure (PTP) edits do show that a modifier can be used to override the edit for 73140 and 73130. For example, it would be appropriate to use the LT/RT modifiers to override the edits to indicate that the finger and hand x-rays were done on different hands.

However, if they were performed during the same encounter on the same contiguous structure (finger and hands), a modifier isn't appropriate to use.

It would be the same hand. So I don't think the RT/LT modifier would be appropriate.