Question Humana Denials: Why Does Humana Request Bilateral Modifier 50 for Non-Bilateral Body Parts?

KStaten

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Hello Everyone. :)

Does anyone else have issues with Humana denying injections for non-bilateral body parts (such as a left shoulder and right knee injected on the same visit) because they are requesting the bilateral modifier 50, rather than the correct LT/RT; XS modifiers ? Is there a way to avoid this without having to call Humana each time to explain that a shoulder and a knee are not bilateral body parts?

Thank you in advance,
Kim
 

thomas7331

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Yes, payers do stupid things like this. (We have a payer in the area where I work that requires the LT or RT modifier on codes such as lesion excisions and closures if the code description refers to an arm or a leg, even though you can have multiple lesions on the same arm so the modifier is really of very little information.)

Having worked for several payers, my experience has been that many of them do not even employ coders, or if they do, the coders have little authority or input into the final decision-making process of how claims are paid or how the claims systems are programed. Not to get on a soap box here, but it's just one of the many headaches of dealing with these large bureaucracies, and these things are unfortunately probably here to stay and best taken as a cost of doing business that we have limited control over. If you represent a large provider group or hospital system that has some clout with the payer, though, you may be able to have some success in pushing back on things like this.
 

SharonCollachi

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Is there a way to avoid this without having to call Humana each time to explain that a shoulder and a knee are not bilateral body parts?

Yes. Just do what they want. ;)

I would call this a "pick your battles" situation, or "do you want to be right, or do you want to be happy?" If you want to be right, you call them each time and try to avoid muttering under your breath that they are idiots. If you want to be happy, you do it their way, while proclaiming, out loud, in your office, that they ARE idiots.
 
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