Denials of 69990

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February 5, 2015

Question:

I get denials on 69990, the microscope code, when I billed it with 22551 (ACDF). I have a few payors that do reimburse but Medicare does not. Should I be using modifier 59 on 69990 to get paid? Please help me appeal these denials.

Answer:

No – do not use modifier 59. Doing so would be an inappropriate use of modifier 59. Do not bill 69990 because it is included in 22551 per CPT guidelines. Even though the code descriptor for 22551 does not specifically say 69990 is included, this information is included in the guidelines for 69990. And, remember, just because you bill a code and get paid doesn’t mean you should have billed it!