I really hate to belabor this point but the fact is that CCI edits are not the issue nor is the fact that the patient is or is not a Medicare patient. The original question was in regards to 64483, 64484, 64484.
And the fact that the 2nd 64484 was rejected for payment. The first 64484 needs no modifier but the 2nd one does since it is a duplicate code. This is absolutely appropriate use of the 59 modifier to allow proper adjudication of the claim. There is no reason to let a claim deny or reject before you "fix" it. I too have coded spinal procedures for about 20 years now and I have always listed them in this fashion for all payers in many different states. We use modifiers when we need them for clarity on the claim, not just for CCI edits. I really hope this clarifies the issue for everyone.
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join