Wiki Stent exchange code

[willoughbyclan]

I have coded a cysto w/right double-J stent exchange (removal and replacement) as 52332 with no modifier. However, a Humana Medicare replacement plan has denied with code 4 (procedure is inconsistent with modifier used or a required modifier is missing) and code N657 (This should be billed with the appropriate code for these services).

Any ideas or help?

Thanks in advance.

 

[JEYCPC]

Have you called the carrier? Or looked on their website?

 

[nateich]

try adding RT...

 

[mlblake]

I agree, add the "RT" modifier

 

[michelleaapc2012]

Yes, you have to list the RT or LT or Humana will deny every time. I have even hasd them deny when the modifier was listed on the EOB. They paid it and then later sent a letter requesting an overpayment because there was no modifier. I called them and said this is crazy because the modifier is clearly listed on the EOB you sent us with payment amount. They didn't care and I had to file an appeal and send the op note.

 

[JEYCPC]

try adding RT...

Good to know!