Wiki Repeat x-ray performed by different provider and facility

[SMorris13]

Hello.
A patient came into the office following a fall and had an x-ray of the facial bones. We billed and E/M and 70510. We received a denial because the same procedure had also been performed by another facility not affiliated with our group. I am not sure if the patient had this x-ray done before or after her visit with us. We submitted a corrected claim with modifier 77, and it still as required modifier missing or invalid. The only thing I can think of is that the other facility billed using the 26/TC modifiers, while we did not.
Is there another modifier that could be used here?

 

[CBLENNIE]

Is the denial a bundling edit denial, if not what exactly is the denial reason code or message? I don't know why modifier 77 didn't work to override the denial except that maybe the payer thinks that the was intentionally as a repeat procedure, when in fact you didn't know the procedure had previously been performed by another provider.

As for possible modifiers to indicate that these were separate services by different practitioner you could try one of the X{EPSU} modifiers. I think "XP-Separate practitioner, a service that is distinct because it was performed by a different practitioner" is your best option, but you could also try "XE-Separate encounter, a service that is distinct because it occurred during a separate encounter."