Wiki ICD elective generator replacement with return for fx lead replacement same day

[BonnieJ123]

I have received a denial from Medicare. I billed 33263 for the elective ICD generator replacement for a dual lead ICD:leads were disconnected from device and tested. Leads attached to a new generator. Then, returned the same day to procedure room due to a fractured right ventricle lead that was dissected free and removed from generator. A new lead was inserted into the right ventricle. I added modifier 59 to 33263 knowing there is a CCI edit stating these can never be billed together however since the patient returned to the procedure room I added modifier 59. Would modifier XU be more appropriate or am I billing the wrong CPT codes for this scenario? Please advise and educate me. Thanks

 

[Margaret Morgan]

Okay, Bonnie, I am making an assumption here are you did not list all the codes billed.
3263 for generator exchange, 1st time in the OR/procedure room.
33244 and 33216 for 2nd trip to the OR/procedure room.

I agree that the CCI edits state these should never billed together, but I think you have an argument as these were separate session.

I would not use 59 or XU, as 33263 has a 90 day global, but 78 modifier on your appeal. You might lose, but I feel you have an right to appeal this unusual situation.

If this had been a situation that I would have use the 59 modifier, I would have selected XE over 59 or XU.

Sincerely,
Margaret​