Medical Billing Forum

Billing => Billing => Topic started by: Adnare01 on October 25, 2017, 04:39:45 AM

Title: Billing 93280 & 93288 together
Post by: Adnare01 on October 25, 2017, 04:39:45 AM
Hi,

I have got a claim in which doctor has billed CPT codes 93280 and 93288 together in an Office facility? do we need to append any modifier?? I think we we add modifier 59 with any one of the CPT?

Need Advice.

Regards,
Tayyab
Title: Re: Billing 93280 & 93288 together
Post by: Michele on October 25, 2017, 07:10:19 AM
Are you the biller or the coder?  If you are the biller and not a coder then you shouldn't append any modifier without either the provider or a coder who has access to the patient's chart advising that it is appropriate.  Many billers fall into the trap of "I've got to get the charge paid" but our job as billers is not strictly to get the charge paid.  Obviously it is the billers job to make sure that the provider is being reimbursed properly for all services that they are entitled to being reimbursed for.  Appending a modifier strictly to get the code paid is fraudulent.  The patient's chart must support the services billed, including the modifier.  It is certainly ok for a biller to go back to the provider or coder and ask if they meant to include a modifier with the service if you notice something that is not reimbursed without the modifier.  Our providers appreciate when we do that for them.   Sometimes they forgot to indicate the modifier and checking with them saves an adjustment or corrected claim.

I don't mean to be a "negative Nancy" but it is so important that the biller understand that they are liable if they append modifiers that are not supported.

So with that being said, 93280 is for programming and 93288 is for interrogation.  They seem like two separate services that would not require a modifier if performed separately.  Did you receive a denial?  Or are you just questioning if a modifier would be appropriate?   

Title: Re: Billing 93280 & 93288 together
Post by: Adnare01 on October 25, 2017, 08:25:16 AM
Thanks for explaining the whole thing Michelle..

Actually my doctor is a cardiologist...and we got these codes for the first time...since we are responsible for all his billing so we cannot ask him to add a modifier or not..I thought we can add modifier 59 just wanted to have a second opinion.

Cheers!
Title: Re: Billing 93280 & 93288 together
Post by: PMRNC on October 26, 2017, 09:11:30 AM
Quote
since we are responsible for all his billing so we cannot ask him to add a modifier or not..I thought we can add modifier 59 just wanted to have a second opinion.

Yes, responsible for billing is one thing, coding is another. I would send the claim to the provider asking him to check his documentation and clarify. With that said....

Both Medronic and Boston Scientific  say NOT to bill those two codes together.
http://www.medtronic.com/content/dam/medtronic-com-m/mdt/crdm/documents/2010cpt-codes.pdf - Medtronic

https://www.bostonscientific.com/content/dam/bostonscientific/Reimbursement/RhythmManagement/2015/2015%20Billing%20and%20Coding%20Guide%20for%20Rhythm%20Management.pdf  (specifically pg 74) - Boston Scientific
Title: Re: Billing 93280 & 93288 together
Post by: Adnare01 on October 26, 2017, 12:49:43 PM
thanks! that helps
Title: Re: Billing 93280 & 93288 together
Post by: Michele on October 27, 2017, 06:49:35 AM

Both Medronic and Boston Scientific  say NOT to bill those two codes together.
http://www.medtronic.com/content/dam/medtronic-com-m/mdt/crdm/documents/2010cpt-codes.pdf - Medtronic

https://www.bostonscientific.com/content/dam/bostonscientific/Reimbursement/RhythmManagement/2015/2015%20Billing%20and%20Coding%20Guide%20for%20Rhythm%20Management.pdf  (specifically pg 74) - Boston Scientific

That makes sense!  When I read the description of the codes I wondered why they would do both of those in the same visit.  Maybe it's actually an error on the provider's part.  I would definitely go back and make sure that was sent over correctly.