Bcbs modifier issue

bsurovick

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I have been billing for a nephrologist for over 2 years now, and he does some time in the ICU also. He will insert a tunneled cath (36558) for dialysis in the hospital, as well as attend to the dialysis (90935/90947). I have been billing these codes together for over 2 years and never had a problem.

All of a sudden, Blue Cross is denying the dialysis codes stating it's in the global of the cath insertion. I understand the 36558 carries a 10 day global, but I would expect denial for an E/M. Not the dialysis being perfomed because of the cath insertion. How is my doc suppose to do the dialysis without the cath? BCBS is telling me to modify every dialysis code I bill for 10 days after the insertion. I have appealed this because even Medicare tells me I don't need a modifier. BC came back stating i need the modifier. I took it to provider relations, told them Medicare doesn't require a modifier. They told me i still need it.

Has anyone else had to deal with this?

Bridget
 

elenax

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Stuart
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Unfortunately, every insurance has their own coding guidelines even though the majority rules by Medicare but as you know they are constantly changing...for instance Medicare would accept the LT/RT modifiers for certains procedures but for Medicaid you put those modifiers and the claim will get denied...so if they are saying it needs a modifier, try billing with it.

Hope this helps!!
 

amjordan

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Also, hopefully BCBS has given you this direction in writing. If you don't have it in writing, request it and then keep it on file. There is nothing wrong with coding per carrier guidelines, but having it in writing will help you if for some reason down the road they told you wrong and want their money back.
 
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