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Medicare Modifier Help, Please...FY, TC specifically

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PippiT:
I think I'm having comprehension problems, can someone please tell me if I understand correctly? (links will be provided)

I have a claim that was separated to expedite handling and one CPT code was denied as being unprocessable, invalid combinations of modifiers, procedure code inconsistent with modifier used or required modifier is missing.

This is the rejected code:

73630, RT, FY, TC - Google is telling me that FY needs to be the primary modifier.

This part of the claim is still in process:
99213
73630, 26, RT

I googled sequence of modifiers and found this: https://www.supercoder.com/my-ask-an-expert/topic/new-fy-modifier-for-radiology

Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) are sequenced after payment modifiers, if multiple modifiers apply. If multiple informational/statistical modifiers apply, you may sequence them in any order (as long as they are sequenced after any payment modifiers).

Now, as per above scenario, modifiers LT seems to be an informational modifier and FY seems to be payment modifier, so FY should be sequenced first. but what about TC? I'm really confused on the TC and if it can be billed per the fact sheet here: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00094625&_afrLoop=1212081827951801#!%40%40%3F_afrLoop%3D1212081827951801%26contentId%3D00094625%26_adf.ctrl-state%3D14786ouc3m_62

Pertinent information is the Professional and TC were both done by the same physician in the office. So does that mean the TC cannot be billed?

Michele:
So the 73630 RT FY TC was denied stating "unprocessable"?  Is that the only denial information?  The FY should only be on the TC portion of the xray and I don't see where it matters if it's in the first location or the second.  I would first check to see if there is any other denial codes.  If not, I would call and ask for additional explanation of the denial.  They may be able to point you to an LCD or NCD.  To me it appears to be coded correctly.

PippiT:

--- Quote from: Michele on February 07, 2018, 11:21:03 PM ---So the 73630 RT FY TC was denied stating "unprocessable"?  Is that the only denial information?  The FY should only be on the TC portion of the xray and I don't see where it matters if it's in the first location or the second.  I would first check to see if there is any other denial codes.  If not, I would call and ask for additional explanation of the denial.  They may be able to point you to an LCD or NCD.  To me it appears to be coded correctly.

--- End quote ---

Denial codes are as follows:

CO-4: The procedure code is inconsistent with the modifier used or a required modifier is missing.

M20: Missing/Incomplete/Invalid HCPCS

MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

N519: Invalid combination of HCPCS modifiers.

I will call again and see if I can get someone more helpful. The one I spoke to yesterday said he couldn't tell me what modifier to use, I wasn't asking him to I just wanted to understand that is when I googled and found those links.

PippiT:
I got a CSR that was a little more helpful.

She said:

If the x-rays were done twice, on the rejected  one, the TC needs to be first modifier

If no, the 26 modifier needs to be removed and the FY needs to be added for the type of film used.

I'm still confused but not as bad. I just need to verify 2 sets of xrays were done because the notes aren't very clear to me.

Michele:
Wow, that is interesting.  I have not ever had a situation where the order of the modifiers made a difference.  Hopefully this straightened it out for you!

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