Please help with modifier 80

[cathywint]

We sent out a claim for 92933 mod 80. Medicare paid but BCBS sent us a letter stating that it is an invalid CPT / mod combination. I am having some difficulties on find documentation to help me either appeal or write off.

Thanks- Cathy

 

[kessel]

Cathy,
If you look at your Physician Fee Schedule 92933 does not allow for an assist. I believe MDCR made a mistake and you should probably refund MDCR and rebill without the 80 modifier.

 

[Kisalyn]

Hmm...I'm seeing on the MFSDB a status indicator of zero for assistant at surgery (0=Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted to establish medical necessity).

I ran it through my encoder and it shows modifier 80 allowed with documentation. BCBS may have their own edits in place for this service. You can try sending in your documentation and showing that Medicare paid.