nursing home mnodifier

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SAN ANTONIO
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Need help with finding which modifier to use for a patient in a nursing home that was seen by our pain management crna for hyalgan shots which is not related to why she is in a nursing home. Can someone please let me know or direct me where I can find the answer. I tried modifier 26 and it was still denied by medicare.

Thank you

Melina
 

spodiane

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St Johns, Florida
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You said 'still denied by MCR' so I am assuming you first sent the charge without a modifier? Perhaps it does not require any modifier, or perhaps they think it should be a 59? Sorry not to be much help.
 
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SAN ANTONIO
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they first paid and then came back and took the money back. they said it needed a modifier so I looked and re sumbitted with a 26 and they said it was inappropriate to be reported or used with the service. I am not sure where to search for the answer that I need.
 

thomas7331

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Did your provider use their own supply of medication for the patient they saw in the nursing home? It's the responsibility of the facility to bill drugs that are administered within that facility - the cost of medication is included in the rates that Medicare pays to the facility. Your provider should arrange with the nursing home's pharmacy to have the drugs available to administer there. That's most likely why you're seeing this denial. You might try to get reimbursement directly from the nursing home for this.
 

thomas7331

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Here's some additional information that might help:

https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/Index.html

Consolidated SNF billing requires that the nursing home bill for any services that inclusive during a covered stay in a nursing home, even if the patient was seen in your office. If you provided services that are included as part of the SNF consolidated billing, you'll need to invoice these to the nursing home. The nursing home should reimburse you the Medicare eligible amount for this.
 
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