deanaTuorto1!
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I work for a vein specialist. Starting in 2018 we began receiving denials on a cpt code we have been billing for over 10 years. We routinely bill codes 36475, 37766 and 36471 together on the same dos; using an RT or LT modifier. And using a 51 modifier on the 37766 and 36471 on our commercial claims. Claims were always paid. In 2018 the CPT 36471 changed to no longer carry the 10 day global period that it used to carry and as far as I am aware nothing else changed on this code.
Since this change we are receiving denials on the 36471-51 CO-231 mutually exclusive procedures cannot be performed in the same session; when we bill it with 36475 or 37766.
However, if we bill it as 36471-51, 79 with the 36475 or 37766 because it is being performed within a global period of another procedure - it pays.
We do not use the 51 modifier on our Medicare claims and we are not having any issues getting paid by Medicare - only a few of our commercial payers; specifically BCBS and UHC plans.
Does anyone have any insight or having the same problems?
Since this change we are receiving denials on the 36471-51 CO-231 mutually exclusive procedures cannot be performed in the same session; when we bill it with 36475 or 37766.
However, if we bill it as 36471-51, 79 with the 36475 or 37766 because it is being performed within a global period of another procedure - it pays.
We do not use the 51 modifier on our Medicare claims and we are not having any issues getting paid by Medicare - only a few of our commercial payers; specifically BCBS and UHC plans.
Does anyone have any insight or having the same problems?