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36245 & 75630 denied

  1. Question 36245 & 75630 denied
    Medical Coding Books
    2010 claim

    93510(26)- paid
    93543 - paid
    93545 - paid
    93555(26) - paid
    93556(26) - paid
    36245 - not paid
    75630(26) - not paid

    why are these not being paid?

    Thanks for all your help...

  2. #2
    Location
    Phoenix, AZ
    Posts
    620
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    Without looking at the report - add -59 modifier to 36245 and 75630 but ONLY if they were performed as separately reportable procedures.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. Default
    Quote Originally Posted by Cyndi113 View Post
    Without looking at the report - add -59 modifier to 36245 and 75630 but ONLY if they were performed as separately reportable procedures.

    Yes and you have to have a payable dx.
    Theresa CCS-P CPMA CCC ICDCT-CM

  4. #4
    Default
    What makes these 2 procedures seperately reportable or under what circumstance can they not be billed seperately?

  5. #5
    Default
    Quote Originally Posted by coders_rock! View Post
    2010 claim

    93510(26)- paid
    93543 - paid
    93545 - paid
    93555(26) - paid
    93556(26) - paid
    36245 - not paid
    75630(26) - not paid

    why are these not being paid?

    Thanks for all your help...
    I think the reason they are not getting paid, is that 75630 is a non selective charge. 75630 is a Abdominal aortogram with distal run-off from a single catheter position. 36245 is a selective catheterization. If this a Medicare patient, then use G0290 for 75630.

    HTH,
    Jim Pawloski, CIRCC

  6. #6
    Default
    Quote Originally Posted by Jim Pawloski View Post
    If this a Medicare patient, then use G0290 for 75630.
    Perhaps you mean G0278 for non-selective iliac angio during cardiac cath instead of G0290 (the Medicare code for DES stenting)? If so I agree, putting 36245 and 75630 together as presented makes me suspect there's an issue with the way the account was coded originally. Impossible to tell without the op report though.
    Last edited by rpcarrillo; 05-23-2011 at 05:44 PM.

  7. #7
    Default
    Quote Originally Posted by 131343 View Post
    Perhaps you mean G0278 for non-selective iliac angio during cardiac cath instead of G0290 (the Medicare code for DES stenting)? If so I agree, putting 36245 and 75630 together as presented makes me suspect there's an issue with the way the account was coded originally. Impossible to tell without the op report though.
    Your right, I was trying to use my memory during lunch when I wrote this. Not good!

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