Wiki Code 94664 with Modifier 59

[Jetzabel Nassiry]

Hello everyone, I'm a new Coder/Biller straight out of school currently working at a Pediatrician's Office. I recently submitted a claim to Medicaid/SmartChoice billing for a CPT 99214 with Modifier 25; 94010 and 94664 with Modifier 59. Payment for 94010 and 94664-59 was denied. Reason for denial states "Procedure considered redundant to primary procedure performed". Anyone Please help

 

[dsantos1]

I just checked the CCI edits for 94010 and 94664 and there are no conflicts, meaning the 59 modifer is not required. I would appeal the decision and send notes showing both were indeed done.
Unfortunately, Medicaid doesn't pay for much, you may also want to call them to see if both tests are covered.

I hope this helps



Deb Santos, CPC, CPMA