Hello everyone,
I am having great difficulty with all Humana HMO's when it comes to billing bilateral xrays and now bilateral large joint injections. I have always billed my xrays (and still do with all other insurance companies) on two lines with an RT and an LT on each separately. Humana has decided they need to bundle my xrays into one line with a 50 modifier and only pay for one. I know according to CMS guidelines xrays are not subject to multiple procedure rules. I have always billed my injections on one line with a 50 modifier, one unit, and double the price. Now with ICD10, I put the diagnosis for each joint on the line with that bilateral procedure. Humana is now denying my services stating "missing, incomplete, invalid other diagnosis". These are shoulder injections, so there is no bilateral diagnosis and I am having to use each separate for right and left. I am so frustrated because it isn't easy to talk to anyone at Humana. They just keep telling you the same thing, which isn't an answer really. Any input would be most appreciated.
Cindy Chalk, CPC
I am having great difficulty with all Humana HMO's when it comes to billing bilateral xrays and now bilateral large joint injections. I have always billed my xrays (and still do with all other insurance companies) on two lines with an RT and an LT on each separately. Humana has decided they need to bundle my xrays into one line with a 50 modifier and only pay for one. I know according to CMS guidelines xrays are not subject to multiple procedure rules. I have always billed my injections on one line with a 50 modifier, one unit, and double the price. Now with ICD10, I put the diagnosis for each joint on the line with that bilateral procedure. Humana is now denying my services stating "missing, incomplete, invalid other diagnosis". These are shoulder injections, so there is no bilateral diagnosis and I am having to use each separate for right and left. I am so frustrated because it isn't easy to talk to anyone at Humana. They just keep telling you the same thing, which isn't an answer really. Any input would be most appreciated.
Cindy Chalk, CPC