pchamp25
Networker
Hi All!
I am having trouble with my billing dept and HPHC. We are getting denials on modifier 59 when attached to a second colonoscopy or EGD CPT code. Example, we bill 45385 & 45380 59 and HPHC denies 45380 as being inclusive. I found the HPHC payment policy explaining these will be denied but my billing manager is fighting to get these paid. If I am correct, if an insurance policy has a specific rule, that rule is final. It does not matter how many times we appeal, there will always be a denial. Correct?
I am having trouble with my billing dept and HPHC. We are getting denials on modifier 59 when attached to a second colonoscopy or EGD CPT code. Example, we bill 45385 & 45380 59 and HPHC denies 45380 as being inclusive. I found the HPHC payment policy explaining these will be denied but my billing manager is fighting to get these paid. If I am correct, if an insurance policy has a specific rule, that rule is final. It does not matter how many times we appeal, there will always be a denial. Correct?