Bilateral Sclerotherapy

Greetings!

I have a quick question - one of my providers performed bilateral sclerotherapy at the same encounter.

The patient is Medicare eligible.

I followed general billing instructions for the bilateral procedure:

ICD-9 454.8

36470-LT (CO-96; N362)

76942 (CO-97; N111)

36470-RT (CO-96; N362)

76942 (CO-96; N362)

Medicare has denied all the line items with the remark and adjustment codes listed above.

N-111 No Appeal Right except duplicate claim/service issue &

N-362 The Number of Days or Units exceeds acceptable maximum.

I am aware of the 76942 listed on the MUE list so I plan to adjust one of the needle placement charges.

However - I am pondering the correct modifier to utilize and can find no specifics. I'm leaning towards either modifier -59 added to the 36470-RT; modifier -76 to the 36470-RT

OR

the bilateral modifier and bill one line 36470-50 ????

Anyone have any thoughts or perspective to point me in the right direction?

Also, I forgot to mention - I'm in Northern Ca and my MAC is Noridian.

Thanks for your time to my inquiry!

Kathy

Bilateral Sclerotherapy