11981 modifier?

[Rebecca Pate]

I am billing 11981 and J7307 for insertion of Nexplanon, and insurance is denying stating 11981 needs a modifier. There are no CCI edits, and I have no idea what modifier might be called for. Help please!

 

[KMCFADYEN]

Are these the only 2 codes on your claim?

 

[Rebecca Pate]

Yes, the only 2 codes. I would maybe understand if there was an office visit. The insurance is PeachState.

 

[Bready]

11981 modifier

are you using a family planning diagnosis code?

 

[CodingKing]

FP modifier is required under GA Medicaid when billing for family panning services. Looking at this document from 2013 (not sure how up to date) Page 32
http://dch.georgia.gov/sites/dch.ge..._of_Public_Health_Billing_Resource_Manual.pdf

 

[KMCFADYEN]

Some insurance require FP modifier

 

[tmc59]

Would a laterality modifier be needed Lt or Rt based on which arm it is inserted???

 

[nielynco]

Would a laterality modifier be needed Lt or Rt based on which arm it is inserted???

No as the procedure is the same no matter which arm you use and you would never insert in both arms so no differentiation would be required.