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62311 & 72275 denied

  1. Question 62311 & 72275 denied
    Medical Coding Books
    27096 - paid
    77003 - paid
    62310 - paid
    62311 - denied as bundled to 27096
    72275 - denied as bundled to 62310

    is this correct or is there a modifier i can use?

  2. #2
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    https://www.cms.gov/NationalCorrectC....asp#TopOfPage

    Code 62311 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided

    Code 72275 is a component of Column 1 code 62310 but a modifier is allowed in order to differentiate between the services provided.
    Code 72275 is a component of Column 1 code 62311 but a modifier is allowed in order to differentiate between the services provided

    Code 77003 is a component of Column 1 code 72275 but a modifier is allowed in order to differentiate between the services provided.


    72275 could have the 59 modifier when performed with 62310-62311 if for diagnostic purposes. 77003 is considered inherent to 72275 but your example might include where 77003 was performed with 62310 and 72275 was performed with 62311.

    From Encoder, the edit "standards of medical/surgical practice" for 62311/27096 edit. I have not found further clarifcation on appropriate use for 59 with this code pair. I have not looked into it further because I am not seeing the procedures being performed during the same setting with the practice I am working with.

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