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Help with CPT 37195

  1. Default Help with CPT 37195
    Exam Training Packages
    I'm billing Medicare South for 37195 they state not payable by them. I added
    a modifer 26 for the professional component and they now deny it stating
    "procedure code is inconsistent with modifier used". Please help. What modifer would I use?

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Modifier 26 would not be valid with this code - it is for professional services, the work of the doctor in administering the thrombolytic agent.

    Did you also bill E/M for that date? They are supposed to be billable together, but perhaps your Medicare MAC sees it differently than CPT does.

    Have you checked to see if your carrier has an LCD concerning this? I'm not sure who you have - Trailblazer has an LCD, but I didn't know who your MAC was.

    Also, there is no National Fee, it is carrier priced.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. Default 37195
    Yes, I billed a Hospital visit and and critical care with this code on the same DOS with a Modifier 25

  4. #4
    Default
    Did you have any other procedures during this crit care visit? Any CPR or injections you coded? If you did then I would apply a -59 to 37195 or to one of the other procedure codes

  5. #5
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    According to CCI edits, it is billable with Critical Care also. Again, I would check your MAC website for a possible LCD concerning this, or call them. Medicare has their own edits - and since this one is local carrier priced, they (your MAC or FI) could well just not pay it.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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