Q: BlueCross BlueShield denied the CPT 94760 as incidental to the primary procedure code when billed with related primary procedures on the same date of service: 94640 Pressurized or non-pressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes; 94150 Vital Capacity; 94760 Noninvasive ear or pulse oximetry for oxygen saturation, single determination. Can I bill all three codes together, or do I need a modifier?
A: 94760 is bundled into any E&M service performed on that same day according to Medicare guidelines. Most carriers follow that policy. 94640 is bundled into any E&M according to CCI edits, again which most carriers follow.
If these three services were all done as part of an E&M visit then it would not be appropriate to unbundle them. If done at separate documented patient encounters, it would be appropriate to bill with a modifier -59. This highly monitored modifier should only be used if the documentation specifically states that separate sessions did occur and the rationale for the situation.
Jill M. Young, CPC, CEDC, CIMC, is president of Young Medical Consulting LLC in East Lansing, Mich., and the 2009-2010 Chair of the American Academy of Professional Coders Chapter Association.
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