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Follow up to Question ID: 10093 re: 93456 & 93505 CCI Edits

Date: Mar 15, 2018

Question:

You recommended code 93505 only for routine heart transplant rejection surveillance. However, per NCCI edits, the "more comprehensive" column 1 code (93456) is eligible for payment, while the "component" column 2 (93505) is denied unless clinically appropriate with modifier -59. So shouldn't we report 93456 only instead of 93505? Furthermore, the recent OIG workplan only disallows the use of modifier -59 to the RHC code when it's a component of (secondary to) the column 1 code 93505. Not the other way around. Hence, shouldn't we be exploring the possibility of 93456 only or 93456 and 93505-59 in this scenario, instead of 93505 only?

Question ID : 10153
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