tgutierrez
Networker
I have a strange one for you.
Our BCBS provider pays the highest billed charge as the primary procedure so when billing for bilateral procedures, the charge is doubled sometimes causing the bilateral procedure to be primary when, in fact, it was another procedure with a higher RVU value. It's in they guidelines and our contract with them states we follow the guidelines so that is the way it has been since day one.
We now have a new boss (not a CPC) and she had us bill a trial one seperating the bilateral procedure code onto two lines with a modifier 59 on the second line. This was successful in that the reimbursement came back the way it should but the coders on staff are not comfortable with this way of coding bilateral.
As we reviewed of the definition of Modifier 59, we do not feel it is the appropriate way to code. We feel it is being coded this way for more money, which we all know is not the way to code.
The boss states that BCBS is forcing us to code/bill this way in order to recieve the 'correct' reimbursement.
Does anyone have any additional thoughts or guidance on this issue? Maybe some official rules or guidelines for us to reference?
Thanks for any help you can provide.
Our BCBS provider pays the highest billed charge as the primary procedure so when billing for bilateral procedures, the charge is doubled sometimes causing the bilateral procedure to be primary when, in fact, it was another procedure with a higher RVU value. It's in they guidelines and our contract with them states we follow the guidelines so that is the way it has been since day one.
We now have a new boss (not a CPC) and she had us bill a trial one seperating the bilateral procedure code onto two lines with a modifier 59 on the second line. This was successful in that the reimbursement came back the way it should but the coders on staff are not comfortable with this way of coding bilateral.
As we reviewed of the definition of Modifier 59, we do not feel it is the appropriate way to code. We feel it is being coded this way for more money, which we all know is not the way to code.
The boss states that BCBS is forcing us to code/bill this way in order to recieve the 'correct' reimbursement.
Does anyone have any additional thoughts or guidance on this issue? Maybe some official rules or guidelines for us to reference?
Thanks for any help you can provide.