Wiki Bilateral Sclerotherapy

[katfitzpat]

Greetings!

I have a quick question - one of my providers performed bilateral sclerotherapy at the same encounter.
The patient is Medicare eligible.

I followed general billing instructions for the bilateral procedure:
ICD-9 454.8

36470-LT (CO-96; N362)
76942 (CO-97; N111)
36470-RT (CO-96; N362)
76942 (CO-96; N362)

Medicare has denied all the line items with the remark and adjustment codes listed above.
N-111 No Appeal Right except duplicate claim/service issue &
N-362 The Number of Days or Units exceeds acceptable maximum.

I am aware of the 76942 listed on the MUE list so I plan to adjust one of the needle placement charges.

However - I am pondering the correct modifier to utilize and can find no specifics. I'm leaning towards either modifier -59 added to the 36470-RT; modifier -76 to the 36470-RT
OR
the bilateral modifier and bill one line 36470-50 ????

Anyone have any thoughts or perspective to point me in the right direction?

Also, I forgot to mention - I'm in Northern Ca and my MAC is Noridian.
Thanks for your time to my inquiry!
Kathy

 

[katfitzpat]

Just a quick follow up to my own question -

After some research and couple of phone calls to my MAC (Noridian) I was lucky to get a phone rep who was very helpful.

The results:

The 36470 is on the MUE list - thus - if a bilateral procedure is performed - it has to be billed on one line (1 unit) with modifier -50.
Multiple procedure rules = 1.5 allowed amount to be paid.

The 76942 is also on the MUE list - date of service specific - one/per day/per patient encounter.
Can only report once and expect payment for 1 line (1 unit).

To be honest - not really liking the MUE list........