Wiki visit denied due to modifier 55

Create Wiki
J

jebond123

Contributor
Messages
19
Location
Vancouver, WA
Best answers
0
Our patient was seen and treated surgically at the local hospital for an ectopic pregnancy. She was told to follow up with her gyn, which she did. I submitted 99213 with modifier 55 (icd10 O00.90) and it was denied stating: "The procedure code is inconsistent with the modifier used or a required modifier is missing. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.N657 : This should be billed with the appropriate code for these services." Am I wrong in my usage of modifier 55? Any help is greatly appreciated.
 
jebond123 said:
Our patient was seen and treated surgically at the local hospital for an ectopic pregnancy. She was told to follow up with her gyn, which she did. I submitted 99213 with modifier 55 (icd10 O00.90) and it was denied stating: "The procedure code is inconsistent with the modifier used or a required modifier is missing. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.N657 : This should be billed with the appropriate code for these services." Am I wrong in my usage of modifier 55? Any help is greatly appreciated.
Click to expand...

Here are some instructions on Modifier 55 from the Noridian website - it looks like the physician providing the postoperative management should be billing the surgical code with modifier 55, not an office visit.


  • Physician rendering additional postoperative care
    • Submit claim with surgery date and procedure code
    • Include date span of assumed care in Item 19 narrative of CMS-1500 claim form or electronic equivalent
    • Submit claim with number of units as 1
 
sls314 said:
Here are some instructions on Modifier 55 from the Noridian website - it looks like the physician providing the postoperative management should be billing the surgical code with modifier 55, not an office visit.


  • Physician rendering additional postoperative care
    • Submit claim with surgery date and procedure code
    • Include date span of assumed care in Item 19 narrative of CMS-1500 claim form or electronic equivalent
    • Submit claim with number of units as 1
Click to expand...
Thank you - much appreciated!
 
You must log in or register to reply here.
Top