Wiki Modifiers - 92273/92274

[adubose88]

Seeking additional information on these codes. Provider is billing for both and recently there have been several denials stating the the required modifier is missing when being billed together. What modifier is the insurance referring to? Are there any other codes that may be considered bundled when the provider performs either one? I am having this error consistently with Medicare part B (for MI) and Blue Cross Blue Shield (for MI) on several claims when there is only a 92273 or 92274. Any input would be helpful as the insurances are not giving me any insight as to why. Thank you.

 

[thomas7331]

It's hard to say without more information - it could be a number of different things. Some payers may require a laterality modifier on these codes. Or, if the services are performed in a facility, they may be needing the 26 modifier to show that it is a professional component. Or there could be a specific payer policy that requires a modifier for another purpose. To know for sure, you'd really need to speak with the payer or to review their policies.

 

[adubose88]

It's hard to say without more information - it could be a number of different things. Some payers may require a laterality modifier on these codes. Or, if the services are performed in a facility, they may be needing the 26 modifier to show that it is a professional component. Or there could be a specific payer policy that requires a modifier for another purpose. To know for sure, you'd really need to speak with the payer or to review their policies.

Thank you. This is helpful. I did not consider that could have been a possibility as they had previously paid before without further complications.