sinus endoscopy with additional bil ear tubes

Melissa-ASL-PMB-07

Networker
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99
Location
Richmond, IN
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Hello,
I had a claim deny for Medicaid of Indiana for the billing of 31231 when billed with a 69436-RT-59 & 69436-LT-59. The 69436s pd but denial says 31231 is bundled. I cannot find anything on this. I could not find any NCCI edits either. If this is not billable please explain... Or should I fight this one with an appeal? This is for an ASC.
Thank you! All comments are greatly appreciated! :)

~Melissa R, CPC
 

bethh05

Expert
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291
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I would appeal the claim. There are no CCI Edits bundling these codes. You might want to check your contract, our MCD program (in Missouri) requires us to bill bilaterals with a 50 modifier, and they do not recognize some of the modifiers.
 
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