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58340, 58555

G

Girlzsmom66

Guru
Messages
124
Location
Bellevue, NE
Good morning! I am in hopes that someone could help me figure out why (which), modifier would be needed if a sonohysterogram was done three days prior to diagnostic hysteroscopy. AETNA states a modifier is needed and also says they are included in the global fee for the procedure. Neither claim was paid.

Any suggestions would be appreciated!
 
Both 58340 and 58555 have 0 global. In my opinion, there should be no modifier required done 3 days apart. Is it possible there was another procedure prior that has a global?
 
AETNA...... ask them for a written copy of the guideline they used to make this determination. They often have internal policies that are published on the web we are required to know.
They are likely looking for mod 58
 
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