Wiki Medicare payment for new stents codes

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cmramon

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Hello

I start coding the new 2013 stents codes for Medicare and they are denying the claims. My doctor had documentation for: 93458-26,59 and 3 stents that I code as follow:
92928-RC
92928-76,LC
92928-76,LD
Medicare paid the cath and the 92928-76,LC and denied the other 2 stents. The 92928-RC was denied: invalid modifier- ? and the other as duplicate. Of course GA Medicare has no answer. Can some one help??
 
Why are you using the 76? That is for repeat procedure but I don't see stents as a repeat procedure, moreso, I think he is treating lesions of different major coronary arteries. I would remove the 76's. You have the modifiers for the coronaries representing each one in a different and distinct vessel. It could be the carrier, they may want a 59 before "LD, LC" respectively.

HTH
 
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I was following the Terry Fletcher guide for 2013. She have the second stent with the mod. 76. Actually Medicare paid the stent with the modifier 76 and denied the other 2. Even the modifier RC alone was denied by invalid. You think this is a Medicare issue?

I will try the modifier 59.

Thank you

Clara
 
It could be any number things, what are all the codes you billed with modifiers and the dx codes you linked to each one. That might help, it may be we would need a copy of the note also.
 
We have been told that Medicare had a gliche in their system for the RC modifier, this has now been corrected and claims need to be resubmitted...we are sending ours today.
 
cmramon said:
I was following the Terry Fletcher guide for 2013. She have the second stent with the mod. 76. Actually Medicare paid the stent with the modifier 76 and denied the other 2. Even the modifier RC alone was denied by invalid. You think this is a Medicare issue?

I will try the modifier 59.

Thank you

Clara
Click to expand...



Ah. Had not heard that. Learn something new all the time! Thank you.
 
92928-59

I billed

92928
92928-59

and the second was was denied as a duplicate. Anyone having any luck with these?

What to do?
 
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