Wiki Multiple Procedures 49322, 58670, 58563 & 57460

[lcathey@smsc.org]

Good morning,

I hope someone can assist us with this claim. We billed this out with the procedure codes in the above order without any modifiers. We checked the CCI Edits and no modifiers were needed for any combination of the codes.

We were denied on 49322 as incidental to 58670 but I don't read them to be similar at all or find any rules stating such, and CPT guidelines state that 58670 excludes 49322. We researched once we got the denial and we resubmitted the claim with 51 modifer on 49322 along with all hospital surgical documentation and Cigna upheld their decision.

After further research, I have found 51 is not a CCI valid modifier for any of theses procedures. Would we now attempt using a 59 modifier on 49322?
Any help would be greatly appreciated.

Thank you

 

[Bready]

multiple procedures

Hi,
It looks like you were trying to bill multiple laparoscopies and that is why the carrier considers 49322 incidental to 58670. Same site. I would try sending a corrected claim with a 22 modifier on 58670 and your documentation(op report with 49322 portion highlighted) and explanation that 58670 included more work and should be reimbursed accordingly. see what they say to that. good luck.

 

[lcathey@smsc.org]

Thank you so much! 22 wasn't on the CCI valid list of modifiers for any of these either, but we will give it a try!