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Thread: Medicare Denials

  1. #1

    Unhappy Medicare Denials

    AAPC: Back to School
    I billed M'care for the following procedures 69100x2 w/ a modifer -50.
    They came back and denied the claim with the following reason:
    The procedure code is inconsistent with the modifer used or required modifer is missing.

    Can someone please give your suggestion in regards to a modifer or if no modifer should have been used. Could I have just used a -59?

  2. #2
    Join Date
    Apr 2007
    Yuma, Arizona

    Default BX External Ear

    Medicare should accept the modifier 50 - however each MAC can process diffferently. You should check to see if your MAC has specific instructions on how to bill for this procedure. Modifier 59 will also work but 50 is more specific, which is the purpose of the modifier.

  3. #3
    Join Date
    Apr 2007
    Greeley, Colorado


    I think -59 is most appropriate since you are doing separate lesions. According to Trailblazers (J4 MAC), bilateral is not appropriate.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Join Date
    Apr 2007
    North Carolina


    CMS fee schedule has a payment indicator of 0 (zero) for 69100.

    0=Do not use modifier 50

    Depending on your carrier, you may need to use 59 to denote a separate biopsy.

    **Just saw Lisa's post---I agree **

  5. #5
    Join Date
    Apr 2007
    Yuma, Arizona

    Default Opsi

    The outpatient status indicator in addendum B is "T" so I guess it just depends on what type of service you are billing (i.e. physician or facility - outpatient).

  6. #6


    CPT 69100 is not inherently bilateral, modifier 50 is not applicable, modifer 59 is appropriate for the 2nd procedure.

    CT ENT

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