Wiki Humana & code 92928

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jessica1974

jessica1974

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Having a problem getting 2 stents in 2 separate vessels paid by Humana. For instance Dr. places a stent 92928 in the LD and then another 92928 RC. They are paying one of these but not the other. Stating that the # of units billed exceeds the allowed amount. Is anyone else having this problem? If so what you are doing to fix it? We have appealed these many times. Should we be billing with a 59 on the other stent? I can't seem to find anything on the Humana website.
Thanks for any help.
 
are you billing on two separate lines using the RC and the LD modifiers? If so then yes try using a 59 on the second line. SOme payers do not recognize the RC and LD modifiers on physician claims as they are designated as facility modifiers.
 
Yes mam. I am billing one without a modifier and one with a 59. I just got a denial again by Humana with the modifer 59 attached to the 2nd one. I am at a loss now.
 
We've been billing like this: 92928-LD
92928-51-RC
and if a cath was done with it, you add mod 59 to the cath code
 
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