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Denial issue for 0075t

  1. #1
    Unhappy Denial issue for 0075t
    Exam Training Packages
    Hello All,
    The physician peformed a LT Vertebral artery stent..we billed 0075T. The claim was denied for modifier needed. The carrier (Medicare) is requesting/suggesting that we add a 26 modifier to the CPT code per our f/u dept.

    This is the first time that we heard that a 26 modifier should be placed on this code?

    Has anyone experienced this scenario from Medicare and/or other carrier? (Michigan)

    Thank you in advance.

    Tawana

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by TBAUSLEY View Post
    Hello All,
    The physician peformed a LT Vertebral artery stent..we billed 0075T. The claim was denied for modifier needed. The carrier (Medicare) is requesting/suggesting that we add a 26 modifier to the CPT code per our f/u dept.

    This is the first time that we heard that a 26 modifier should be placed on this code?

    Has anyone experienced this scenario from Medicare and/or other carrier? (Michigan)

    Thank you in advance.

    Tawana
    Sorry, this is news to me. This code should not require the 26 modifier, please let us know if that works.
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by TBAUSLEY View Post
    Hello All,
    The physician peformed a LT Vertebral artery stent..we billed 0075T. The claim was denied for modifier needed. The carrier (Medicare) is requesting/suggesting that we add a 26 modifier to the CPT code per our f/u dept.

    This is the first time that we heard that a 26 modifier should be placed on this code?

    Has anyone experienced this scenario from Medicare and/or other carrier? (Michigan)

    Thank you in advance.

    Tawana
    Yes, this code breaks down into PC and TC. So, if your physician performed the stent placement in the hospital you need to add the -26 modifier. See the Physician Fee Schedule RVU file, or payment files.

  4. Default ICD-9 code for 0075T
    I was wondering if anyone else was having trouble with a diagnosis code for the 0075T.
    It seem like all the insurance conpanies are allowing are the 433.10, 433.11 & 433.30.

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