Denial??

KaylaRieken

Expert
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Has anyone else ever had this happen?

Patient had a 52356RT done and then two weeks later they go back in and do 52353RT. BCBS is denying the second claim saying it is included in the payment for another service. Do I need to add a 58 modifier to this even though it does have any global days? I think I have done this is in the past, but not sure if that is the correct thing to do.
 

liqgold2@aol.com

Networker
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39
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In this particular case BC/BS are not following coding rules. Bill the second service with modifier-58, what looks like a staged procedure, although as you indicated it is not really needed as the procedures have zero day global and see what happens.
 
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