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Line item denial for 64484

  1. Default Line item denial for 64484
    Medical Coding Books
    Hello,

    I billed out the following procedure codes to Medicare: 64483, 64484, 64484, 27096 and 77003-26.
    Medicare paid all except for the 2nd 64484. Can this be appended
    with a "59" modifier?

    Thank you

  2. Default Denial of 64484
    Appending modifier -59 would not be appropriate. You need to make your quantity 2 units when billing out.

  3. #3
    Location
    Albany, New York
    Posts
    456
    Default
    Description for 64484 is "each additional level".
    Do not have to amend modifier 59 to that code.
    Karen Maloney, CPC
    Data Quality Specialist

  4. Default
    Great, thanks for your help...

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I agree we should not have to append the 59 to the 64484 however when you list it twice it will edit out as a duplicate entry so append a 59 to the secon d 64484 and it will be fine. If you bill with units it is incorrect, units cannot be greater than one for this procedure.

  6. #6
    Default
    What was the reason for the denial? Our FI wants LT or RT for injections administered unilaterally. Mod 59 is not required and although it would probably get it paid, is an inappropriate use of the modifier--something to be avoided with Medicare (or any other carrier).

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Where did you get the information that this is inappropriate usage of the 59? It is not. The LT and RT modifiers are for anatomic specificity, the 59 is the modifier that identifies distinct and separate. When the code states each additional level I agree that it should be implicit with the code that each one listed is a different level, however this is why we have modifiers, when you list an identical code twice we need to alert the payer that this is for two distinct and separate procedures, hence the 59. If each additional level were on say the LT side you would still need the 59 to indicate separate level. This is in no way non compliant for Medicare or any other payer, it is appropriate usage of modifiers to indicate what was done. If you have information from the AMA or CMS to the contrary I hope that you will share this.

  8. #8
    Default
    CCI edits indicate that these codes are not bundled so they should be paid without the use of mod 59. If a modifier is not necessary then the answer lies elsewhere. I don't know why this was denied or if Medicare was contacted to find out how to resolve the denial. We have this happen occasionally and usually end up appealing the denial per our FI's instructions. I would not use mod 59 in this instance unless otherwise instructed by Medicare. You can get info on use of mod.59 at the Medicare Learning Network.

  9. #9
    Location
    Columbia, MO
    Posts
    12,531
    Default
    No you are right they are not bundled that was not the purpose of the modifier. Anytime you list the same code twice on a claim you need a modifier to indicate separate site or separate time of day, there is nothing on the Medicare learning network that indicates or implies that using a 59 to indicate separte level is inappropriate. CCI edits are not the only reason we use modifiers. My objective as a coder is to code what is documented and to do so in a manner as to indicate to the payer what was done to obtain optimal and timely reimbursement. So I maintain there is absolutely nothing incorrect or noncompliant with putting a 59 modifier on a duplicate line item to indicate separate service. Nor is there any instruction that prohibitis this.

  10. Default
    I agree

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