Wiki HELP!! Injections being denied for lateral modifier

[Jenniredd82]

These codes 64520 and 20610/20611 can be used bilaterally. However when our provider performs a Lumbar Sympathetic block or coccyx injection, the procedure is midline, it doesn’t need a left or right. Our problem is insurance companies are requiring a left or right modifier and it is NOT either, it is midline according to the provider and Operative Report.

How is this being handled in the industry and how can we appeal it?

 

[santhiya.p]

These codes 64520 and 20610/20611 can be used bilaterally. However when our provider performs a Lumbar Sympathetic block or coccyx injection, the procedure is midline, it doesn’t need a left or right. Our problem is insurance companies are requiring a left or right modifier and it is NOT either, it is midline according to the provider and Operative Report.

How is this being handled in the industry and how can we appeal it?

Since the bilateral indicator for these codes are 1 which means Laterality modifier or 50 modifier is required. Hence it is normal for payor to deny the claim. If there is no supportive document in your report for laterality you can add the same reason in your appeal form. Each payor have different format of appeal form. While I was working in Denial we had template for each insurance. Iw would suggest you to read the payor billing guideline for these procedure before appealing to avoid claim getting denied again and again

 

[amyjph]

Yes, check with the payer guidelines to see if they have a policy about how to submit this first. You would have to check which ones are denying.