Correct modifier needed

Patient has mitral valve replacement (33430) in addition thoracotomy (32100). Thoracotomy is being denied as bundling with code 33430. Medicare indicates that modifier is needed. Any assistance would be appreciate.

Correct modifier needed

Why was the thoracotomy done that was separate from the valve replacement?

correct modifier needed

The NCCI edits say that code 32100 is a component code of 33430, but a modifier is allowed IF and ONLY IF the procedure was a separate, distinct, procedure. The modifier that overrides the edit is 59.

But, before you bill it, look at the definition of the modifier 59. Was it a separate session? surgeon? Lesion ? incision? What makes this procedure separate and distinct from the first? If nothing, don't bill it.

33430 has 75 RVU's. 32100 has 32 RVUs. If you bill with a modifier incorrectly, and get paid for both, you can be sure that this is the type of service that will get the attention of your MAC on review.