Wiki 96132, 96138, 96139

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Kris78

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Hi.
Can someone shed some light on CPT codes 96132, 96138, 96139.
I keep getting denials for 96138/96139 from Wellmed stating issues due to technical component modifiers. This is done by the tech.

They also keep denying 96132 when billed with the office visit.
The denial feedback is very vague and there are no edits preventing me to bill for them together.
Insurance has me in a loop - saying they'll send it back for review and then come out with the same initial denial reason.

Any help would be appreciated.
 
You may want to read the CPT guidelines for this section of codes again. There is also a table (in the professional edition book) for these services.

Are you attempting to append a TC modifier to 96138 & 96139? When you say "technical component modifiers"? If so, why would a TC be appended? There is no such thing with these two CPT. Just because a technician is performing a service doesn't mean a TC is appended. I would suggest some further reading on the proper use of modifiers 26/TC.

Does the payer follow NCCI edits? Did you check the code pair you are trying to bill? (e.g.; 99214 & 96132 together)
Did you check the payer guidelines and policy for these procedure codes? These are timed CPT and have specific time requirements.
 
I'm not appending any tech modifier since that isn't applicable and that's why it's so confusing to me.

Traditional Medicare pays with no issue at all.

The thing about payor guidelines - Sometimes they are well hidden and the rep isn't the easiest to get a hold of. :)

I will continue to dig....

Thank you :)
 
Oh I see what you are saying now. I was not understanding. What does the denial specifically state? They may have some crazy policy where they want a weird modifier.
They could also have their own mod 25 policy or even one where you can't bill E/M on the same date as 96132.
 
How many units do you usually bill for 96139? My provider does more than the allowed 11 units (5.5 hours) and we're trying to figure out how to bill that and get paid rather than having the patient come in 2 separate days. He usually does 9 hours of testing
 
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