Question Tri West and modifier 59

[bbeatty]

I am from Pennsylvania and recently we are having issues with Tri West (Veterans insurance) when we bill using a 59 modifier. For instance, if we bill 45385 and a 45380-59 they are denying the second procedure. Today someone at Tri West "hinted" that we should not be using any modifier. Is anyone else having issues with Tri West and modifiers?

 

[kathrynw]

Hi,
Per NCCI edits these do require a modifier. You could look at using one of the X mods instead of the 59. Documentation should support the procedures were performed in different sites of the colon and on separate lesions.