pharrison
New
Can anyone help me find the correct answer to this issue, please? I have a few different scenarios, so I'm looking for feedback on how these should be coded appropriately.
Scerario 1: 83350 was billed 5 with units; payment for 4 units was only received, and insurance is looking for a modifier. (MUE is 9, MAI is 3) Would this just need to be appealed? Or does a modifier need to be added? (We are under the MUE so not sure why there would be a modifier required.)
Scerario 2: If CPT 86255 was billed with 9 units, 4 units (unpaid) on one claim and 5 units (only 1 unit paid) on another, but different specimens. (MUE 5, MAI 3) One paid, the other 8 denied as a duplicate. What modifier would be used? Should these all be on 1 claim in order to receive payment for all units?
Scenario 3: Labs were billed out and paid for in house but then rebilled with modifier 90 for the additional tests done by the outside lab. This scenario then puts us over the MUE's, would these just be appealed for medical necessity?
Lastly, when billing these labs, my understanding is all labs should be billed with the CPT up to the MUE and then the appropriate modifier with the additional units on the next line.
I appreciate any feedback and clarity on this. Thank you.
Scerario 1: 83350 was billed 5 with units; payment for 4 units was only received, and insurance is looking for a modifier. (MUE is 9, MAI is 3) Would this just need to be appealed? Or does a modifier need to be added? (We are under the MUE so not sure why there would be a modifier required.)
Scerario 2: If CPT 86255 was billed with 9 units, 4 units (unpaid) on one claim and 5 units (only 1 unit paid) on another, but different specimens. (MUE 5, MAI 3) One paid, the other 8 denied as a duplicate. What modifier would be used? Should these all be on 1 claim in order to receive payment for all units?
Scenario 3: Labs were billed out and paid for in house but then rebilled with modifier 90 for the additional tests done by the outside lab. This scenario then puts us over the MUE's, would these just be appealed for medical necessity?
Lastly, when billing these labs, my understanding is all labs should be billed with the CPT up to the MUE and then the appropriate modifier with the additional units on the next line.
I appreciate any feedback and clarity on this. Thank you.