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Modifiers for EGD & Colonoscopy

  1. Default same question
    Medical Coding Books
    I have a doctors office who coded a colonscopy with 45383, 45385 -59, 45384 -59 and an EGD 43239 - 59 and cant seem to get paid by BC/BS can any help me with this?

  2. Question
    In regards to the modifier 59. We are an ASC and GHP has not been paying for our second procedure (i.e. 45385 and 45380-mod 59). they claim its a bundled code. Noticed on the Remittance Advice that they have been changing the modifier to a 51 (51 is not recognized in an ASC setting) So some claims are paid and some are not. It depends if GHP changed the modifier. I have a call out to our Rep. waiting for reply. Anyone else having these issues?????

  3. Default
    Quote Originally Posted by mamacase1 View Post
    I have a doctors office who coded a colonscopy with 45383, 45385 -59, 45384 -59 and an EGD 43239 - 59 and cant seem to get paid by BC/BS can any help me with this?
    BC/BS only pays for one procedure in an ASC setting. You will have to write off the rest. But in a physicians office they pay on multiples.
    Last edited by NARCHER; 09-24-2009 at 10:24 AM.

  4. #14
    Default
    We are always paid with use of mod-59 by Blue Cross. On occasion, Healthnet or Providence will deny the second code, but they are always overturned and paid on appeal. Definitely appeal these

    Julie

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