Wiki Qualifying Procedure or Modifier Issue?

[kfrycpc]

I had billed the following:

99203 - 25
97597 - 59
29580

The 29580 was denied for "lack of qualifying procedure". I don't know why. I believe I have the modifier 59 correctly placed on 97597 as that has the lower RVU. Any idea on what I did wrong on this one? Is this a modifier problem or something else?

Thanks!

 

[OCD_coder]

I know this is a late reply, but an interesting question. Here is an article by Supercoder that shows the modifier 59 should be applied to the 29580.

http://www.supercoder.com/my-ask-an...or-unna-boot-medicated-dressing-and-unna-boot

Medicare:
100 - Surgical Dressings, Splints, Casts, and Other Devices Used for Reductions of Fractures and Dislocations
(Rev. 1, 10-01-03)
B3-2079, A3-3110.3, HO-228.3,
Surgical dressings are limited to primary and secondary dressings required for the treatment of a wound caused by, or treated by, a surgical procedure that has been performed by a physician or other health care professional to the extent permissible under State law. In addition, surgical dressings required after debridement of a wound are also covered, irrespective of the type of debridement, as long as the debridement was reasonable and necessary and was performed by a health care professional acting within the scope of his/her legal authority when performing this function. Surgical dressings are covered for as long as they are medically necessary.
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

 

[dclark7]

You can't go by RVUs when adding modifiers you need to check the NCCI edits for column one and column two codes. There are many codes bundled into codes with lower RVUs. Also if this was a medicare patient check the LCDs, NCDs.