Results 1 to 5 of 5

Mod for 99291 and 36556

  1. #1
    Location
    Prescott, AZ
    Posts
    67
    Cool Mod for 99291 and 36556
    Exam Training Packages
    Physician has given me charges for CCU time 100 minutes plus 36556. This is a Medicare patient. CCU is 99291 and 99292.

    I have billed to Medicare in the past (5/2010) and this same billing was denied; Medicare considers 36556 minor surgery and will only pay the lesser of charges. They denied both 99291 and 99292, paying only 36556. I called to get more info and was told no modifier could seperate these 2 services.

    This just doesn't seem right. Before I submit this claim, does anyone have any thoughts or suggestions??? I would think there is some Modifier that could seperate these and get all paid. 25, 59 ??? Help!!!

    I am in Arizona, so we are with Noridian in North Dakota for Medicare.
    Tracy L. Wood, CPC

  2. #2
    Location
    Springfield, MO
    Posts
    17
    Default
    In Missouri we would bill

    99291-25
    99292
    36556

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default -25 modifier
    I would add the -25 modifier to BOTH 99291 and 99292

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by tlwhlw View Post
    Physician has given me charges for CCU time 100 minutes plus 36556. This is a Medicare patient. CCU is 99291 and 99292.

    I have billed to Medicare in the past (5/2010) and this same billing was denied; Medicare considers 36556 minor surgery and will only pay the lesser of charges. They denied both 99291 and 99292, paying only 36556. I called to get more info and was told no modifier could seperate these 2 services.

    This just doesn't seem right. Before I submit this claim, does anyone have any thoughts or suggestions??? I would think there is some Modifier that could seperate these and get all paid. 25, 59 ??? Help!!!

    I am in Arizona, so we are with Noridian in North Dakota for Medicare.
    Interesting. I pulled up the codes under the CCI edits in Encoder Pro and they are not bundled and there are no available modifiers under CMS for any of the codes. So you should be able to bill all three with no modifiers and be reimbursed under Medicare.

    If they deny, pull up the CCI edits, print them off and send them with the appeal. There is no LCD for Noridian for these codes.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Location
    Springfield, MO
    Posts
    17
    Default
    99291 is in the E/M section of the CPT book so you would need to protect that service from the procedure with a 25 modifier IF the documentation states the decision for the procedure was made. It is not necessary to put a 25 on 99292 as it is an add-on code as it is linked with the primary code and is not needed. Our EHR has a scrubber that will kick these out if an modifier is placed on an add-on code

Similar Threads

  1. Cabg done with a 36556
    By dpumford in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 07-13-2015, 02:28 PM
  2. 93620, 36556
    By amym in forum Cardiology
    Replies: 0
    Last Post: 01-28-2013, 10:22 AM
  3. 36147 & 36556
    By Lynda Wetter in forum Interventional Radiology
    Replies: 4
    Last Post: 02-13-2012, 01:59 AM
  4. Mod AI on 99291?
    By AmandaW in forum E/M
    Replies: 2
    Last Post: 11-17-2011, 03:29 PM
  5. What diagnosis to use for 36556?
    By tfischer in forum Diagnosis Coding
    Replies: 3
    Last Post: 01-15-2010, 12:55 PM

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.