BCBS Modifier Denials

Joiaw

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Is anyone else getting denied for claims with modifier 25, 58, and/or 59?
Denial reason: The procedure code is inconsistent with the modifier used or a required modifier is missing.

Every single claim we have submitted this year is getting denied. I have submitted claim reviews with medical records and it has been over 60 days. The claim reviews are still processing. I wanted to see who else is having the issue and what steps are you taking to get the claims paid.
 

Joiaw

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Ex 1:
99214, 25
20550, LT
j1020

Ex 2:
99213, 25
11750, T5

BCBS is paying for the procedure, but not the E&M. They are saying it's an invalid use of modifier. I am hearing this is an Oklahoma/Texas issue.
 
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I am also having issues with Mod 58 denials from BCBS Texas. With the same reason :confused:

Here is my example:
DX: S62.337D
99024
29085-LT, 58
Q4010
 

Orthocoderpgu

True Blue
Local Chapter Officer
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Salt Lake City, UT
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Thinking out loud here...

A couple of years ago BX made a change to their system and they started denying office visits stating that they were "bundled" with X-rays. Image that, 99203 bundles with 73562. Anyway, their CSR did not know any better so we had to appeal these. It took them three months to identify and correct their system.

I'm wondering if them denying E/M charges with -25 modifiers is intentional? or if this is another computer glitch like before?

BX?

Buhler?
 

eminey

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I'm having trouble too!

Same here - since the beginning of the year. I have been fighting dozens of claims. Sent them to the provider rep who is "looking into it." We do tubes and adenoids at the same setting. 30 days later the pt comes back. Note only mentions ears, no adenoid diagnosis or mention of adenoids. Claim has a 24 on the E&M and is getting denied as being within the global for adenoids.
Also having issues with debridements in the post-op period for a septo. Debridement related to sinuses, not septo. 79 modifier. No pay. Over and over again. So frustrating. Requesting outside appeal if this continues.
 

Joiaw

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We have been appealing every single denial. I have yet to receive payment for any of my appeals, only appeal denials.
 

Joiaw

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My denial reason:

Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is new or established.

I find it weird that BCBS-OK are saying "per Medicare rules" when Medicare still pays on these type of claims.
 
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Denials here too...

Our Rads use PA's, so if PA performs, we code L Myelograms as 72265-52-59 for Interp only, under rad and 62284-59, under PA. Have had some 72265's pd and also some denied as "Proc inconsistent w/mod or missing", same problem w/62284-59.

62284 is bundled into 72265, therefore -59 mod and also
72265 is bundled into the CT from same dos, therefore -59 mod.

They just don't seem consistent with their denials.
Anyone else seeing this inconsistency?
 
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