Medical Billing Forum
Coding => Coding => : tina7627 July 28, 2020, 10:18:55 AM
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I was wondering if anyone knows why Medicare would keep sending a claim to RTP for Edit 92 Modifier Bypass with codes 63650 and 96365. The claim has 63650 with C1778; which I believe is what would make the claim not want the CG modifier. I have tried several different ways to correct this claim, but it continues to give the same rejection. Can anyone give me some direction or even maybe know what the problem is?
Thank you!!
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I'm sorry but I'm not sure what RTP is, or what Edit 92 is saying. Can you give more information? It's really not possible to help with the information given.
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RTP is return to provider. Means there is something wrong with the claim so Medicare will not process it until corrected.
There are certain procedure codes that need to have CG modifier on them if they are to be billed without a device.
It states on the error "A DEVICE DEPENDENT PROCEDURE IS REPORTED WITHOUT A DEVICE CODE. Effective 01/01/2019 the edit maybe be bypassed when device procedure from "Edit 92 Modifier Bypass" list is reported with modifier CG. See the BYPASS_E92_MODIFIER column in the DATA_HCPCS table in the IOCE quarterly data files on the CMS IOCE website."
I already went through these reports and called Medicare several times. Medicare can't tell me how to code so I am not sure which code is missing the CG modifier. My guess right now is 96365 since I already tried CG modifier on the 63650. I just don't want to guess.
I hope this helps.
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I have not billed those codes before, however, with what you are describing it seems that the CG would go on the C1778. Have you tried that?
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I have not. I will try that. Thank you. I will let you know if it works or not.
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I tried it and it jumped right back in to Return to Provider. :'(
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That's strange. It doesn't make sense to put it on any other code. Are all lines denying? Or just one?
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No lines are denying. I have modifier 59 on 96365. I have modifier FB on C1778. I am not getting paid for that code, because it was given to us. I have that as non-covered charges. The rest is not denying. Just wants the CG modifier. It doesn't make sense to me either.
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That is so strange. You've tried the CG modifier on the codes that it would make sense to put it on but I'm not a certified coder. I'm just not sure what else to suggest. Maybe the CG has to go on the C1778?
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It is very strange. I even pulled a couple claims from last year to compare and no CG modifiers. They both paid. Not sure what is different in 2020. I tried it on all services now. None took the CG modifier. The only other things left are the REV codes. I don't believe I can put a modifier on a REV code.
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I don't believe you can either. Are you billing this on a UB04?
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Yes I am billing on a UB04.
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I have not done a lot of billing on UB04s but I have never seen them require a modifier for a HCPCS or CPT code. I thought they went on the REV codes which don't get modifiers. I've also never had the RTP a claim, they either pay, deny, or pay some lines but deny others. I wish I could be more help.
I know Medicare will not "tell you how to code" but they should be able to at least point you to documentation to explain the requirements for what you are billing. Maybe try calling back to ask for an LCD or NCD that addresses the issue?
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Okay I will do that. Thank you.
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