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Medicare Denial on modifier 78--Anesthesia Billing

  1. Smile Medicare Denial on modifier 78--Anesthesia Billing
    Medical Coding Books
    We added a modifier 78 with cpt 00560 as patient had to return to operating room after a CABG. I used icd 998.11
    Medicare keeps denying for :

    M80 Not covered when performed during the same session/date as a previously processed service for the patient.

    I have filed the claim 6 times. Can anyone please advise me on this?


  2. #2
    Hartford, CT
    You said you filed the claim 6 times, have you appealed the claim with supporting documentation?
    Doreen Clark, CPC, CPMA
    Medical Auditing Specialist
    Integrated Physicians Management Services
    East Harftord. Ct

  3. Smile
    no I haven't but I will today. My thought was that if the patient is taken back to OR the same day due to complications or in this case hemorrhaging, if I submitted with 78 modifier, claim would be considered. At a lower amount but still considered. I will send appeal today. Thanks!

  4. Smile Kelly B
    Hi - we had the similar situation - after reviewi and running some coding edits- we belive that the 78 can only be added to the surgery code not the ASA code- we have submitted the claim with the apprioprate form and records to Medicare.

  5. Default
    Hi Kelly, so we are not the only ones to have this ongoing problem. You comment does make sense, to think about it. Maybe it is for surgical codes only. I am going try submitting with documentation, and if still no payment, may need to look at if using the 78 mod is even beneficial to us as we are only anesthesia.
    I have called Medicare and no luck on any answers.


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