Wiki 59 modifier

Create Wiki
J

jbartunek1

New
Messages
7
Location
West Valley City, UT
Best answers
0
I work for a genetic testing laboratory, we currently bill CPT 81229 (CMA) and 81243 (Fragile-X) together and we have always billed these with a 59 modifier on the 81243 with great success. Recently, we have had a couple of Regence payers deny the 81243 -59 as inappropriate coding combination, so we removed the modifier and now it is being denied as inclusive.

Does anyone else have this issue or even something similar? If so your advice would be greatly appreciated.

We have considered the X modifiers but none of them seem appropriate for our situation.
 
I am looking for more information on this as well. When is it appropriate to bill 81415 and 81243 on the same DOS? Also should 81243, 81415 and 81416 all be bundled to 81229?
 
You must log in or register to reply here.
Top