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adding modifiers on ASC claim

MichaelSL

Contributor
Messages
23
Best answers
0
Where would you apply modifiers to these codes in the ASC setting? Only the 13132 paid. This is an Aetna claim. The denial does state the codes denied for the charges included in the contracted and/or case rate so I'm not sure if that's referring to a grouper for the ASC..?

11402
11442
13120
13132 paid
11444
 

thomas7331

True Blue
Messages
2,059
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0
There are no CCI edits between any of these codes, so no modifier should be necessary unless your Aetna plan follows different guidelines from NCCI. You would need to review your Aetna contract to know whether or not this is paid correctly, but from your description it does sound like this is paid at a single case rate that includes all of the procedures under that single payment.
 

MichaelSL

Contributor
Messages
23
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0
Thank you for your reply. The Aetna contract isn't specific, or at least I cannot find the specifics within that address the grouper/case rates. If you have any other information or resources regarding navigating or negotiating the grouper/case rates, please message me. I am new to ASC. Thanks again!
 
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