GY or GZ when billing Category III codes to Part B

Good afternoon-

We are seeing denials with "CO-4-procedure inconsistent with the modifier or a required modifier is needed". Since it is a Category III code, it is not on the MPFS. Any suggestions on if a GY or GZ would be a better choice? Currently, no modifier is being listed, and no ABN was collected.

Thanks

Donna

Donna M. Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CIMC, CEDC, CFPC, CCP-P, CRP
Certified Green Belt Lean Six Sigma
Assistant Director, Patient Financial Services

[Emory Healthcare]


Comments

  • I can bet that's what it is. But what doesn't make sense is that the MAC'S have a policy on it and state the codes or service is by a case by case basis, I have appealed several of these and they don't pay!

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