ollielooya
True Blue
Ok, how does one go about resolving issues when a claim is denied for incorrect surgery-modifier combination when using -50 with 64612? I verified it as assignable with MCR status indicators and also with the major carrier who is refusing payment whose own policy states that it is allowed. Provider Relations basically said they can't help and recommended we file an appeal with supportive documentation. Yikes! I pulled up documentation to that effect and sent it certified mail. I tried "playing" with the McKesson edits at the website and there is no conceivable way to get it to accept a bilateral modifier. So, basically it looks like 1) we bill without modifier and accept the payment, 2) bill with modifier 50 and receive the rejection to 3) followup with claim action request, and if that doesnt' resolve the issue.......4) appeal...and then what? Perhaps the code descriptor is what triggers the edit by AMA standards? Just not sure.
Is there an alternative fix to this messy issue? Any input from those of you who may have encountered a similar situation with the editis even if it regards a different code?
---Suzanne E. Byrum CPC
Is there an alternative fix to this messy issue? Any input from those of you who may have encountered a similar situation with the editis even if it regards a different code?
---Suzanne E. Byrum CPC