tci Part B Insider - 2011 Issue 39

Reader Question: Not All Modifier 59 Denials Warrant Appeals

Question: I have an insurance company that is not paying for a code, stating it is bundled into another code. We are billing 52353, 52352-59, and 52332-59. My doctor is doing a cystourethroscopy with ureterscopy and/or pyeloscopy with a holmium laser lithotripsy. He is then doing a basket extraction of multiple stone fragments, not just irrigating the stones out. Then he is placing a stent in the ureter. The insurance company is saying the 52352 is part of 52353. My doctor is saying this is a different procedure though it is the same anatomical site. I haven't had any...

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