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what modifier for cpt 95970 and 99214 or 99244

  1. Default what modifier for cpt 95970 and 99214 or 99244?
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    Doctor sees a patient and during visit he makes an adjustment to his VNS implant. The diagnosis code needs to be 345.5x, what modifier would get both services paid? Commercial insurance requires a modifier, Medicaid does not. I appreciate your help.

  2. #2
    Default
    Hi,

    I looked up your codes on CCI Edits and it shows that the 99214/99244 would require a -59 modifier to "unbundle" it from the 95970.

    Also, just a pointer....be careful how you word your questions. You don't use modifiers to "get things paid", you use them to indicate to payors that services normally considered "bundled" are in a specific case not so, to accentuate the accuracy of coding, and so on....not to "get things paid". I get what you're asking but don't want your statements to be misinterpreted and cause you problems.

    Hope this helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. Smile
    Thank you.


    Quote Originally Posted by thompsonsyl View Post
    Hi,

    I looked up your codes on CCI Edits and it shows that the 99214/99244 would require a -59 modifier to "unbundle" it from the 95970.

    Also, just a pointer....be careful how you word your questions. You don't use modifiers to "get things paid", you use them to indicate to payors that services normally considered "bundled" are in a specific case not so, to accentuate the accuracy of coding, and so on....not to "get things paid". I get what you're asking but don't want your statements to be misinterpreted and cause you problems.

    Hope this helps!

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