cswaggard
New
Hey, so I'm having a problem with Humana denying physical therapy charges for modifier 59 not being an appropriate modifier. I am trying to bill therapy codes 97110, 97150, 97140, 97112 and 97012. According to NCCI edit if 97150 & 97110 are billed together only 97150 will be paid, if both 97150 & 97140 are submitted only 97150 will be paid and if both 97012 & 97140 are submitted only 97012 will be paid. I have always added the 59 modifier to the code that will not automatically be paid in the pass and charges were paid, but now they are denying for the following: THIS CLAIM CONTAINS CODE PAIRS FOUND TO BE UNBUNDLED ACCORDING TO CMS AND NCCI. THIS SERVICE WAS INCLUDED UNDER A MORE APPROPRIATE PROCEDURE CODE ON THE SAME DATE OF SERVICE. NCCI states that 59 modifier is for Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. In this case services were on the same day but patient had group therapy and did manual therapy. I'm trying to see what modifier is needed, Can I get some assistance? Thanks