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Thread: Medicaid plans denying cath codes

  1. #1
    Join Date
    Apr 2007
    Location
    Ocala, FL
    Posts
    26

    Question Medicaid plans denying cath codes

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    Hi all!

    Lately I've noticed that the PUP, Freedom, and UHC Medicaid plans have been denying my cath codes (ie: 93458-26) as "not eligible charge" or "not Medicare allowed".

    I heard somewhere that they don't want the -26 modifier. Does anyone have any info on this? Thanks!

  2. #2
    Join Date
    Apr 2007
    Location
    Richardson, TX
    Posts
    817

    Default

    I always bill our caths with a 26 bc we do them in the hospital so we can't bill the global code. Is the cath being done with a stent or PTCA? If so, then you need to append modifier - 59 to the heart cath.
    Julie Graham, BA, CPC, CCC

  3. #3
    Join Date
    Apr 2007
    Location
    Ocala, FL
    Posts
    26

    Default

    Thanks for your reply.

    No it's not a -59 issue, they are denying caths by themselves. That's why I don't want to remove the -26 b/c how would they know that it's not global since it's done at the hospital.

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