Wiki Office Visit & Cerumen Removal with Modifiers... HELP

[OneStepAtATime]

Ok, so Blue Cross is giving me a headache... I keep getting different answers from people over there, and it's driving me bonkers.

I have been told by insurance that when I'm billing: 382.00 with 99213 that its needs Mod 25, and line #2, 382.00 with 69210 needs Mod 50 since it's BOTH ears, and bilaterel.

So I go and do this, now it's getting rejected. So then I try just Mod 25 aginst the office visit, and then insurance only pays 1/2 of code 69210 saying it's bilateral and needs Mod 50.

Someone PLEASE tell me how I can bill this to get it paid.

The Claims rep, told me that he knows nothing about how a claim is supposed to be set up, that he only knows that he's supposed to re-read what the notes are to me and can provide no further assistance... grrrrr

 

[mitchellde]

69210 definitly does not get a 50 modifier as the descriptor state one or both ears. BCBS has a nasy habit of trying to discount a procedure when billed with an OV however they are not suppose to do this. Some BC payers have you use the 25 on the OV and a 59 on the procedure to keep it from discounting.