DebbieMac
New
The dental insurance company I work for is starting to accept institutional Medicaid claims for ASC facilities in Fl. The claims are bundled and we are using a pricer to help weight the fees. The claims are starting to come in and the ASC is adding modifier 59 to the dental codes which is unbundling the fees and of course increasing payment. The same codes are billed by the provider separately. The institutional claims forms do not have identifiers (tooth numbers, quadrant indicators) to help differentiate the multiuse of one code. My question is, should modifier 59 be used in this case if the same codes are paid already in the professional claim and bundled in the institutional claim? Any help or guidance would be greatly appreciated. Institutional claims are new for our company. Thanks!