Troy1
New
We billed cpt code 43235 with modifier 53 and medicare denied saying invalid combination of HCPCS modifier. Not sure what that means. What modifier should we have used?
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Wiki Medicare and modifier 53
- Thread starter Troy1
- Start date
xXxPARAGONxXx
Guest
Please post the procedure report (with PII redacted).
We don't know what happened, so we can't determine how it should be coded.
Was it inpatient or outpatient? We have a hard time with that modifier being paid in the outpatient setting.
mpurisima
New
Can you upload a copy of your report? I don't have issues with Medicare paying our claims with modifier -53. Can you give more information? Place of service? Diagnosis?
amyjph
True Blue
Was the modifier being used correctly? What is the place of service? Did the claim have the proper documentation and statement submitted on the claim to support the 53?
You will need to submit PWK paperwork form to Medicare along with records to support using that modifier.
swisssmizz
New
Are you billing the physicians service or the facility's? 53 would be appropriate for the provider however for facility billing you would use modifier 74 for an incomplete procedure.