Wiki 98943

[bakera2]

I need help, please. I cannot figure out how to get UHC to reimburse for 98943 when performed on the same day as 98941. I have billed with modifier 59 and it has been denied. I have read all UHC policies and reimbursement procedures and cannot get an answer. So to restate. I am billing 98941 for a 3 level spinal manipulation and 98943-59 for an extremity adjustment linked to a separate diagnosis and UHC denies as using the incorrect modifier.

 

[OCD_coder]

You don't need any modifier for this code combination.

You would only use a modifier 59 if the procedures bundled together and they do NOT in this example. Think of the modifier 59 as a "last resort" modifier.

A modifier 51 is becoming an elective modifier (applied to the 2nd procedure) anymore as most computer systems will auto-apply them when they are received electronically.

 

[bakera2]

Thanks so much. That was my next step. I will give it a try.