Wiki Add-on codes needing modifier???

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LaSeille

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Anyone had a problem w/ Medicare denying payment on the add-on codes stating that they need a modifer (59) per the CCI edits??? We have had both 49568 (billed w/ 49560) and 15777 DENIED and when we called M/C the C/S rep stating that the CCI edits is kicking it out stating it is "bundled" and needs a modifier! Asked to speak to supervisor who told us the same thing. We have NEVER had this problem before. Told the supervisor this seemed to just start in 2013 (even though some of our dos's are 2012) and she said there was nothing she could do about it. ??????
 
Not sure If I'm getting your question right, but you are billing 15777 and 49568 with a hernia repair 49560? If so, CMS is correct. You can not use 15777 for mesh placement during a hernia repair. Biological Mesh falls under "Other Prosthesis" per parentheticals under 15777 and CPT Assistant 6/08. Hopefully, I'm misinterpreting your question and you haven't been paid for both in the past.
 
Lujanwj...sorry for the confusion. These were two separate patients/procedures! So no, not billing both those with a hernia repair!! The 49568 was with the ventral hernia repair (which was never a problem in the past and did not need a modifier). The 15777 was billed with another procedure (on a different patient) and it was also never a problem in the past and didn't need another modifier.
 
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