Wiki BS Denial 77003

[louettayg]

We are getting denial froms Blue Shield indicating that 77003 is not payable with injection code 62310 stating that is considered inclusive. Is anyone else having this same problem?

 

[mbort]

Who are you billing for...facility, anesthesiologist, surgeon? Are you putting the appropriate modifier -26 or TC on the 77003?

 

[louettayg]

for pain doctor and yes we are attaching the modifier 26

 

[judicline]

I work for pain practice and we use 77003 with the 26 modifier and never get denied for inclusive I would send investigation thru Navanet.

 

[med-biller]

We are having this same problem with Regence BCBS in Utah. They state they use CPT, CCI and various other common guidelines to determine coverage (all of which allow the payment of fluoro). But then they go on to deny based on their own "supplemental" correct coding edits to deny the 77002 and 77003 when billed with some injection codes. Our appeals have been unsuccessful. These guidelines can be found online under their medical policy section.