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90935 & 36514 on same day

  1. Default 90935 & 36514 on same day
    Medical Coding Books
    I have a patient who was hospitalized and my physician has charged for 90935 Hemodialysis Procedure and one of our Nurse Practitioners has charged for 36514 Therapeutic Apherisis, Plasma Pheresis on the same day. I initially billed to Medicaid with a modifier 25 on the 90935. Medicaid has paid the 36514 and denied the 90935 saying "Missing/Invalid/ Incomplete HCPCS". Any ideas?

  2. #2
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    Columbia, MO
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    12,910
    Default
    The 25 is an invalid modifier for that procedure, it is an E&M modifier only. Check the CCI edits and see if the procedures are bundled, and if they are which one is the column 2 edit, that is the one that the modifier is appended to. Depending on the documentation and what was actually performed the correct modifier is probably the 59.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Thanks for the help. Pretty new here and still learning.

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