Wiki corrected claim or appeal?

[Erin9401]

Hope someone can help me understand. Newer coder and no one to ask. CPT 36482 billed with ICD I87.2. Claim originally denied due to invalid modifier and no authorization. Another coder sent a corrected claim with invalid modifier 59, claim denied again invalid modifier. I was asked to make corrections. I've added the laterality modifier per policy A56914 but my dilemma is the claim authorization was denied due to not being requested prior to service. Do you file a corrected claim, then appeal the authorization denial or just appeal claim? thank you!

 

[lfontanez]

If you didn't get a PA prior to the service being rendered, you can try to get a PA now and request it to be backdated to cover that DOS, then submit attaching documentation with a corrected claim (with your corrected modifier(s)). But my understanding is, if you didn't obtain a PA prior and if the insurance carrier won't backdate it, then you'll have to write-off the claim, unless you obtain something in writing beforehand from that patient that they could be liable.

 

[Erin9401]

Thank you for your assistance!!

 

[amyjph]

Agree with the advice above. You have to think about it in parts. You have multiple problems going on. Even if you corrected the claim itself, that's not going to help the no prior auth problem.
The other coder sending the claim back only addressed one part and the wrong part.
Another question is, do you have auth but the claim just did not have the # on it? Or, did you not get auth at all? Fixing the modifiers, etc. is fine but that's not the whole problem.