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Another C097 Denial

  1. #1
    Default Another C097 Denial
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    Another C097 edit for codes 32215,31622, and 32500- These 3 codes were billed together and I'm sure that one or two of them is an inpatient procedure only but I'm not sure which modifier I need to add the 59 modifier for all of them to go through. The edit says the 32215 and 31622 are bundling with the 32500. Any suggestions.


  2. #2
    You may not be able to bill 31622 separately from 32500 - it's considered a component code (separate procedure). If they're unrelated, you'll need a 59 modifier on 31622 to show that it's separate. If it was on the opposite lung, I'd suggest adding LT and RT modifiers to both codes to give more detail.

    The same goes with 32215, except it's not listed as a "separate procedure" in the CPT. Just keep in mind that anytime you have multiple procedures, especially surgeries, on the same date, you're probably going to need a modifier of some sort on one of them, or you'll end up with an inclusive/incident to (CO97) denial.

  3. #3
    Wink PS...
    As a rule of thumb, the code that denies is usually the one that needs a modifier (like, 95% of the time). Check your NCCI edit tables if you're ever unsure. They're available on CMS's website.

  4. #4
    Medical Billing
    Thank you so much for your help and suggestions. I greatly appreciate it!

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