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confused

  1. #1
    Default confused
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    Good Afternoon coding world,

    I know that add on's for debridements 11045-11047 should be in units. The issue I have is with my company. they want to bill using a modifier 76. which I totally disagree because we are not repeating the same procedure subsequently. before april there was a MUE for the add on's for just 1 unit. our add on claims submitted before was denied as duplicated claims. My company would like to just use 76 for the add on's. They rationale comes from a MCR rep and the payment for 76. I disagree with this totally. Do anyone have clarification on this. Are there any crosswalks on modifiers that can be used with a procedure?

  2. #2
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    Default
    you should use the 59 not the 76. The 76 does get higher reimbursement as it indicates the same procedure is repeatedin a different session so there is no discounting. This would be incorrect if it is all performed in the smae session. The codes 11045-11047 are suppose to billed with 1 unit each and you use the 59 modifer to indicate separate segment.

    Debra A. Mitchell, MSPH, CPC-H

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