Question Tri West and modifier 59

bbeatty

Networker
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48
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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

Networker
Administrator
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98
Location
Grantsville, UT
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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.
 
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