Wiki Humana modifier required

[RMyers730]

I know Humana always wants LT or RT modifiers but now they are denying Ventral hernia repairs for needing a modifier. These are in the midline of the body, not right or left?!? How are ya'll getting these kind of claims paid? Thanks!

 

[Deborah Marsh]

Hi - Was there anything else going on with the claim (other procedures)? I also wonder if the general surgery forum might have some answers.

 

[amyjph]

Are you sure they are looking for laterality and not something else? Was this the only CPT billed? What is the associated diagnosis code or codes billed with it?

 

[RMyers730]

Hi - Was there anything else going on with the claim (other procedures)? I also wonder if the general surgery forum might have some answers.

No other procedures so I know they aren't wanting a 59 or anything...

 

[RMyers730]

Are you sure they are looking for laterality and not something else? Was this the only CPT billed? What is the associated diagnosis code or codes billed with it?

Pretty sure, that is the only code billed and the diagnosis is for a ventral hernia. I have another one that is an umbilical hernia denying for the same reason. I'm at a loss... I cannot figure out what they want.