Wiki 59 Modifier and B/C

[carol52]

Hello, I recently got a denial back for Blue Cross stating that they want the 59 modifier and not the XU or any "X" modifiers placed on there claims
anyone have any feedback on that...
This was what I billed for a Bilateral Inguinal Hernia with , Bilateral excision of a lesion on the spermatic cord.
Rt side Hernia was recurrent.
49520 RT
49505 LT
55520 RT 50
55520 LT XU
Thanks
Carol

 

[thomas7331]

Excision of a spermatic cord lesion is almost always incidental to an inguinal hernia repair. As a reference, see CPT Assistant, September 2000. CPT 55520 carries a 'separate procedure' designation, so this should not be billed unless it was a separate - 'unrelated and distinct' - procedure (e.g. performed through a separate incision or at a different encounter).

 

[carol52]

Excision of a spermatic cord lesion is almost always incidental to an inguinal hernia repair. As a reference, see CPT Assistant, September 2000. CPT 55520 carries a 'separate procedure' designation, so this should not be billed unless it was a separate - 'unrelated and distinct' - procedure (e.g. performed through a separate incision or at a different encounter).

Than you Thomas... this was not a separate excision .. I will make a note of this... also is B/C not accepting XU modifier ??
Thanks,
Carol

 

[thomas7331]

Than you Thomas... this was not a separate excision .. I will make a note of this... also is B/C not accepting XU modifier ??
Thanks,
Carol

BCBS operates independently is each state and each one has different sets of policies. It wouldn't surprise me if some of the plans did not accept the X modifiers. Those were created by Medicare a couple years ago and not all payers have followed along with the Medicare guidance on this. If that's the case, then you should still use the 59 modifier as before, when appropriate.