Results 1 to 8 of 8

UHC stating 43248 and 43239 are bundled

  1. Default UHC stating 43248 and 43239 are bundled
    Medical Coding Books
    Hey all,

    UHC is stating that those codes need a 59 modifier and will not pay without one. Is there somewhere I can report this to try and get them to change it other than their own claims department? Has anyone else run into something like this and do you know what my next step is other than just changing the coding with an incorrect modifier?

    Thanks,

    Bob

  2. Default
    The usage of the 59 modifier-Distinct procedural service, is the appropriate modifier to use when billing multiple codes withint the same family of CPT codes to differentiate the codes from one another. This should be required by all payers for correct reimbursement. Hope this helps.

  3. #3
    Location
    Columbia, MO
    Posts
    12,843
    Default
    both of these codes are for a dilation and there fore cannot be billed for the same session. If however they are 2 different sessions on the same day then you can use a modifier to show this. You should never just use a 59 for a bundled procedure, they are bundled for a reason and you can unbundle only when documentation supports it. Without the note I cannot tell whether it is appropriate to append a modifier.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Hey Mitchellde I think you might have misread or I'm missing something, but it was 43239 (egd with biopsy) and 43248 (Egd guidewire dilation).

    Bob

  5. #5
    Location
    Columbia, MO
    Posts
    12,843
    Default
    SORRY I DID MISREAD MY BAD! SO now that I am on the right page I agree there should be no need for a 59, just for grins have you checked the CCI edits for both component of comprehensive and mutually exclusive status? The only thing that makes sense is that they are calling them mutually exclusive. Barring that I see no need for a modifier.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    You do need a 59. go to medicares website and look up "endoscopy families"

  7. Default
    Hey cingram,

    I went to Medicare's website and put "endoscopy families" in the search bar and didn't find anything. I may have been taking your request a tad literal or I was searching in the wrong place. I'm going off of Medicare's NCCI edits from:

    http://www.cms.gov/NationalCorrectCo....asp#TopOfPage

    According to their edits its not needed, but if you see something I'm not please let me know.

    Thanks,

    Bob

  8. Default
    https://www.noridianmedicare.com/sha...es_Updated.htm

    the codes on the left are teh base codes and the codes on the right are all bundled in to that base code. Related endoscopies need a 59 unrelated need a 51. Everytime I have had a claim denied for them bundeling this I call up the insurance and refer them to this document and it gets paid everytime.
    Last edited by cingram; 07-21-2011 at 02:52 PM.

Similar Threads

  1. 43239, 43248, 43453 (?)
    By plynn in forum Gastroenterology
    Replies: 3
    Last Post: 07-26-2013, 02:37 PM
  2. 43239/43248-51
    By lisner1204 in forum Gastroenterology
    Replies: 2
    Last Post: 08-06-2012, 05:05 PM
  3. Cci edits for 43248, 43239
    By kathleenw84 in forum Gastroenterology
    Replies: 2
    Last Post: 11-29-2011, 10:54 AM
  4. 43239, 43248, 43245, have I unbundled?
    By blathrop19@gmail.com in forum Gastroenterology
    Replies: 3
    Last Post: 06-30-2011, 10:46 AM
  5. Uhc denies 93545 as bundled
    By melissa10000 in forum Cardiology
    Replies: 4
    Last Post: 08-19-2009, 07:11 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.