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Wiki Help with CPT 37195

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mag022560

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Saugus, CA
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I'm billing Medicare South for 37195 they state not payable by them. I added
a modifer 26 for the professional component and they now deny it stating
"procedure code is inconsistent with modifier used". Please help. What modifer would I use?
 
Modifier 26 would not be valid with this code - it is for professional services, the work of the doctor in administering the thrombolytic agent.

Did you also bill E/M for that date? They are supposed to be billable together, but perhaps your Medicare MAC sees it differently than CPT does.

Have you checked to see if your carrier has an LCD concerning this? I'm not sure who you have - Trailblazer has an LCD, but I didn't know who your MAC was.

Also, there is no National Fee, it is carrier priced.
 
Did you have any other procedures during this crit care visit? Any CPR or injections you coded? If you did then I would apply a -59 to 37195 or to one of the other procedure codes
 
According to CCI edits, it is billable with Critical Care also. Again, I would check your MAC website for a possible LCD concerning this, or call them. Medicare has their own edits - and since this one is local carrier priced, they (your MAC or FI) could well just not pay it.
 
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