Wiki CPT code 77089 is being denied.

[dnakvosas@yahoo.com]

CPT code 77089 is being denied. Pos is 22, billed with no modifier but then tried 26, then 59. Dx is M81.0 what am I doing wrong? What I read on this code is no modifier.

 

[trarut]

Can you provide the denial reason/codes from the remit as well as which plan was billed? It will help us help you. That aside, with what you provided above, I'm thinking it's a payer-specific edit causing the denial. Have you looked for a clinical or reimbursement policy for the payer to see if they have special guidance for submitting this code?

 

[dnakvosas@yahoo.com]

The 1st one; Medi denied as not covered by this payer (co-109). But medi is their primary ins.
The 2nd one; RMD insurance but Availity said review the POS and Modifier. The POS is 22 and no modifier was used. This does not require a 26 or TC modifier.
The 3rd one; Medi insurance but Availity says MUE. Only one unit of service is allowed. Only one unit was submitted. but did try modifier 59. This is a new code for us as of this month. It became active 01/01/2022.

 

[ShakeraKnox2023]

Same here, 77089 is being build on the same claim as 77080 and is being paid but 77089 is not being paid with BDBS and I don't understand why

 

[dnakvosas@yahoo.com]

CPT 77089 Is anyone getting this paid? If so, what POS are you using? Any modifier?

 

[dnakvosas@yahoo.com]

Same here, 77089 is being build on the same claim as 77080 and is being paid but 77089 is not being paid with BDBS and I don't understand why

I believe I may have solved the problem. See https://www.hologic.com/sites/defau...v_011_Bone_Densitometry_Coding_Guide_2022.pdf. I think we should be using the code 77092. Not 77089. What do you think?

 

[ShakeraKnox2023]

Spoke to our provider and 77089 is the correct coding and this is what we are coding for. Description for the procedure is correct when billing for 77089. Still being denial
Wellcare Medicare- Cpt 77089 denied Procedure Inappropriately Coded per Global and TC/26 rules] .