Incomplete Colonoscopy

ENDOCODER

Networker
Messages
37
Location
Sterling Heights, MI
Best answers
0
Is anyone having trouble getting paid for incomplete colon procedures? We are a freestanding ASC and the Medicare Advantage claims are being denied for using 74 Modifier. We have been billing this way for many years. Our straight Medicare claims are still being processed and paid but for some reason the Advantage claims are denied.
Appreciate any help on how to get these paid.
 

ENDOCODER

Networker
Messages
37
Location
Sterling Heights, MI
Best answers
0
What is the denial reason?
Rejection states, per Medicare guidelines, it is inappropriate to report modifier 74 for a procedure that is discontinued on a professional claim. This modifier is used by the facility to indicate that a procedure was terminated.
We are the facility and we bill on a 1500 claim form. We are freestanding ASC. Just wondering if anyone else is having this type of rejection
 
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