mbcool
Contributor
I work for an Orthopedic group practice and we have been struggling with our Local BCBS plan for the last 2 years and the problem is getting worse. not better. Our hospital E&Ms won't be paid with or without a 57 modifier on the same day a major procedure (of any kind) is done. And in the last year, in the clinic, if our coders miss adding a 25 modifier on the day of a minor procedure (for two completely different problems) BCBS will not acknowledge the 25 modifier and will never pay the E&M. We have exhausted every level of appeal/redetermination they have. Is anyone else having this problem with BCBS of MN or any BCBS? Any Feed back would be helpful. Thanks