Wiki BCBS Denies E/M With Tests, HELP!

[brandyleigh23]

Can anyone tell me the correct way to file BCBS with the following:

99254-25
93306-26
93016
93018
78452-26

We have filed these and they will pay for all except 93306 and 78452 because of "bundling..." Should I be adding a mod-59?? I need some guidance to get this paid. HELP!

 

[jewlz0879]

That does seem strange to me, unless I'm not understanding. Per NCCI, there are no bundles for 78452/93306, so you shouldn't need a -59. Maybe make sure you bill with different diagnosis? I would appeal stating that NCCI does not prevent these codes from being billed together. I don't understand the basis of their denial. I sometimes wonder if insurance companies just make up denials to see if the physicians will fight for their money.

 

[brandyleigh23]

I will try using different dx since some of the tests were filed using the same one. I have several variations of these that are being denied so I may try sending each one out differently (using seperate dx, and adding modifer). I know how much they want to keep their money just as much as we want to get paid! I appreciate your input!