Wiki Is it appropriate to change a modifier on a claim if provider has left practice?

[SarahSee1114]

There is an inappropriate modifier attached to a wellness visit causing the claim to not be paid. The NPP left the practice and the billing office is unwilling to make the correction stating they are unable to change the claim since the provider is gone. I think this would be a function of a routine billing office, to make a correction as it's a clear error. It's the AT acute treatment chiropractic modifier on 99396.

 

[csperoni]

I know nothing about modifier -AT or chiropractic coding. However, as long as documentation supports the coding, there is no requirement that only the clinician may code or correct the coding. Some employers may have this as an internal policy. If your employer does not, there should be no reason the coding cannot be corrected to match the already documented medical service. And even if your employer does have such a policy, there should be a part of this policy that deals with this situation or it was a a poorly written policy.

 

[SarahSee1114]

I agree, just needed some other thoughts on the subject! It's definitely a 99396, it's the AT mod that has no business there. It's a family practice, not a chiro. And I also agree, what a bad policy that wouldn't allow for simple errors. Thank you!