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BCBS 59 modifier

S

salligood

Contributor
Messages
11
Location
West, TX
has anyone figured out BCBS 59 modifier denials?
 
I have not:( I will be following this thread for any advice as well as they are denying everything with a 59, even if CPTs are linked to separate ICD-10 codes that identifies it was a separate procedure. Oh and they aren't denying as bundled they are denying is invalid modifier. They are driving me crazy!
 
I have tried, 59, XS, XU as well as making sure the procedures had the diagnosis codes linked which further showed separate areas and everything has denied....Not as bundled but invalid modifier combo.
 
I have been using xu, and 51. It is paying for my egd's and ercp's. however on the colonoscopies it is still a hit and miss. some pay and some don't. It's really a hassle to send records all the time.
 
Bcbs 59 modifier

We have been told that BCBS is doing an internal on certain modifier and 59 is one of them.. There have been instances where we billed a 59 and edits showed to bill a 51 so the modifiers were changed, but in the case where the modifier 59 is correct, they told us they want medical documentation. So pretty much everything coming through with a 59 is being hit for an audit.
 
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