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Medicare denial & proc code

  1. #1
    Default Medicare denial & proc code
    Medical Coding Books
    Our office billed 44620-78,15330-59 and 36590-59 for a pts dos 2/24/10 to MC; MC pd 44620-78 but denied the other two "pre/post-op care payment is included in the allowance for the surgery/procedure". Checked the CCI and 15330 and 36590 can be billed separately. Does the coder need to change the modifiers or is this a write off?

    Our office also billed 13160-78 (dos 12/22/09), 44312-75 (dos 12/18/09) and 44146 (dos 12/10/09) for the same pt.

    Any suggestions or help is greatly appreciated!

  2. #2
    Columbia, MO
    I am having a problem with the timeline here
    so you started with the 44146 on 12/10 which I believe has a 90 day global
    then 44312 -75 0n 12/18 the 75 is a modifier that does not exist so not sure about that one
    then 13160 78 on 12/22 the 78 is because it is in global and I assume got paid
    then 44620 78 on 2/24 which got paid and is in global but the 78 pulled it out
    then 15330 59 on 2/24 not paid due to global
    then 36590 59 on 2/24 not paid due to global
    Is this all correct?
    If so then you need to correct
    15330 78 59
    36590 79 59
    you must use the 78 and 79 modifiers to pull these procedures out of the global as well

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    the mod 75 was a typo and should have been typed as 78.
    All the cpts were paid except for 15330 and 36590.
    Thanks so much for responding back so quickly re the correct mods!

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