Denial CPT 64405

[binal05080]

Has anyone got denial for 64405 with from medicare with unit 1 and modifier LT

CPT COde POS M1  M2 M3
99214     11    25   X2
64405     11    LT
20552     11    51    XS
J1020      11


All cpt codes are paid by medicare accept 64405 . Shows error : This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.

Any suggestions..

[Michele]

I believe you are missing a modifier but I can't really say because I don't have access to the patient's chart.  It would be irresponsible to advise what modifier simply to get the claim paid without knowing if the notes warrant the modifier.  But if you read information on the 64405 and the 20552 billed together you will see that a modifier is needed if they are separate identifiable procedures, which we cannot tell from the information given. 

[binal05080]

Thanks, I think modifier 50 is required M1 50, M2 LT

[binal05080]

I meant mdf 59 and not 50

[binal05080]

Not sure if it should be 59 or 50 modifier.

[kristin]

Those two modifiers have entirely different descriptions, and only one fits your scenario, if the documentation supports it. Reread the descriptions for each VERY carefully, and you will answer your own question.

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