68761 reporting to Medicare

[cherylbr]

We seem to have confusion on the proper way to submit procedure 68761 when done on the same eye for both upper and lower. In the past Medicare has told us to use modifier 50 with the E1 (upper LT lid) & E2 (lower left lid) modifiers with quantity of 1 and double the fee. Recently, we had those claims reject and have been told by Medicare that they no longer want them reported this way and the use of 50 would not apply. The are saying to report 68761 on separate lines with one having modifier E1 and the other line with modifier E2.

Has anyone encountered this? and what would be the proper way to bill these?

Thank you,
Cheryl

 

[SharonCollachi]

Didn't they tell you how to bill it? What happens when you do what they said to do?

 

[Cheezum51]

If it's Tuesday, you do it one way, but if it's Thursday, you do it another. Just kidding. Don't you love it when you've been filing claims with a carrier a certain way and they've been paid and then all of a sudden they're not paid and they tell you they want them filed a different way?

Saw an article a couple of years ago which estimated that improper processing and unannounced processing changes by insurers cost providers over $2 billion per year in unnecessary extra expenses due to having to refile and appeal etc.