Wiki Modifier use - Visit with 69210

[cdregan13]

We have always billed a visit 99213-25 with 69210-59 to Blue Cross. Recently our claims are denied due to invalid combination of HCPCS modifiers. I can not find a revised edit for a change in these codes/modifiers. Any suggestions as to where I can find this information? Thank you

 

[devinmajor14]

Only bill 69210 with the RT, LT, OR 50 modifier.

 

[erinal]

We have always billed a visit 99213-25 with 69210-59 to Blue Cross. Recently our claims are denied due to invalid combination of HCPCS modifiers. I can not find a revised edit for a change in these codes/modifiers. Any suggestions as to where I can find this information? Thank you

First, I would like to agree w/ the above poster that a 59 isn't necessary on the 69210. But after you correct that it will probably still deny. We recently had the same denial but our procedure code didn't have a 59 on it. We submitted 99204-25 with a procedure code. When we called about the denial, we were told that BCBS will be denying any claims with unbundling modifiers on them. They basically want records to support the separate service. They advised that we submit a claim review form with records. I would just give them a call to see if you get the same information. Good luck!

 

[NiteshlalKoyalkar]

Hi,

CPT 69210 " Removal impacted cerumen requiring instrumentation, unilateral" does not require Mod 59 in this scenario. If previously payment was been made by BCBS then this needs to be called to BCBS and ask for the exact reason of the denial.