Wiki Anatomical Modifiers for supplies?


Kingsley, MI
Best answers
I have an insurance company (Priority Health) that has started denying my "Q" codes (Q4010, Q4006...) for missing anatomical modifier. Is anyone else having this issue? If I apply one, my clearing house denies the claim because of the invalid modifier combination and wont send the claim out but the insurance comp is denying them all without it. Customer service claims department told me to see their provider manual regarding modifier usage because they cant tell me how to bill. Has there been a change that I missed?? Ideas of how to fix this? It has to be a technical issue on their end, right? Why would a supply need anatomical modifier??
Have you read their policy to see what the requirements are? Some insurance companies are more strict than others about which codes they require modifiers for, and sometimes their rules don’t make any sense. You have to understand that these claims processing systems are often programmed by people with limited knowledge of coding rules. Generally speaking though, if a code description includes a body part that is bilateral (arm, leg, eye, ear, etc.) as is the case with your codes here, then there’s always a chance that a payer is going to set it up to require the modifier.