Wiki Blue Shield CCI Edit Issues

[mmgbilling]

I am having issues with Blue Shield. If a patient has an office visit and is then sent for labs (in house full service laboratory) on the same day Blue Shield denies the Office Visit as global when a urine dip (81003) is billed by the lab (we operate under one tax ID number) even if we append a modifier 25 to the E/M. I have contacted Blue Shield as I can find nothing in CCI edits that would prevent both codes from being billed and processed together. I cannot get a straight answer. I did have one rep tell me that they cannot be billed together if the dx code is the same and that the urine dip should have been denied not the office visit but they are denying no matter what the dx is. I have appealed to the highest level and am getting no where. Anyone else having this issue? Any advice? I cannot find any information on CCI edits on the Blue Shield provider portal either.

Thanks so much!!

Christina

 

[gig71078]

Blue Shield CCI Edit Issues

Hi,
I work for a Urologist and we perform UA's everyday with office visits. We append the QW modifier and append our CLIA number to the claim.

Hope this helps!

J. Fox