Wiki RT modifier vs specific finger modifier

[pchamp25]

I am following up on a denial received from the insurance company regarding incorrect modifier used. Patient had MP Joint arthroplasty w/silastic implant R index finger (26531) performed and our coding company used modifier RT. A denial was received due to modifier used but when asked to review, I was advised RT is the appropriate modifier to use for this procedure. From the research I've done, modifier RT OR finger modifier is appropriate, and I can't find concrete information on what is appropriate. I see the procedure is performed at the joint where the hand meets the fingers so can see why modifier RT is appropriate but since the procedure is listed w/R index finger should a finger modifier be used? What modifiers are others using w/26531? Anyone know of a resource I can use to support RT in a denial? TIA

 

[Orthocoderpgu]

This is where you may need to follow the "Golden Rule". The insurance has the gold, so they make the rules. Not every insurance company will see everything the same way. Personally I would have used a F6 modifier. I'm not aware of any "concrete" coding rule for this. I would be more apt to send a corrected claim rather than fighting the denial.

 

[pchamp25]

This is where you may need to follow the "Golden Rule". The insurance has the gold, so they make the rules. Not every insurance company will see everything the same way. Personally I would have used a F6 modifier. I'm not aware of any "concrete" coding rule for this. I would be more apt to send a corrected claim rather than fighting the denial.

Thank you! That was my thought as well

 

[amyjph]

Not worth a battle or appeal, just correct it.